Prevention of Bedsores in Long-Term Care Homes Cost-Effective

Researchers at the University of Toronto have found that low-tech, inexpensive interventions for bedsores could improve health for long-term care residents and reduce health-care costs for the facilities that house them.

For all long-term care residents, pressure reduction foam mattresses were cost-effective 82 per cent of the time compared to standard mattresses, with average savings of 115 Dollar per resident, the researchers showed. Foam cleansers for incontinence care would be cost-effective 94 per cent of the time compared to soap and water, saving an average of 179 Dollar per resident.

The clinical benefits of foam cleansers for bedsores, or "pressure ulcers," however, require confirmation through more research, the team noted.

"These results provide specific evidence to support practice guidelines, which recommend reducing risk factors and improving skin health to prevent pressure ulcers," said Ba' Pham, researcher of the Toronto Health Economics and Technology Assessment (THETA) Collaborative. "We encourage all providers of long-term care to consider these changes," said Pham.

In Ontario, there are approximately 72,000 long-term care residents in 89 facilities. As part of their study, the researchers conducted a phone survey with directors of care at 26 of those facilities, and found that only half their beds have pressure reduction foam mattresses. As well, roughly half of incontinence-care cleanings were performed with soap and water rather than foam cleansers.

This slow uptake of quality improvements in pressure ulcer care in Ontario may be connected to the condition's low profile relative to other diseases. "It is one of those diseases that is kind of silent," said Murray Krahn. "Unlike HIV or breast cancer, there are no advocacy groups marching for pressure ulcers. The patients are seniors with co-morbidities and low mobility in long-term care," he added.

Compounding the condition's visibility problem is that it doesn't belong to a particular clinical group. Patients are cared for by nurses, surgeons, infectious disease specialists, general practitioners and internists, so no one group is well-positioned to champion the cause effectively.

Yet, the disease burden for pressure ulcers is huge. From 5 per cent to 10 per cent of all residents in long-term care facilities have pressure ulcers, and a study pegged the treatment costs of Pham and Krahn in all health-care settings — including hospitals and home care — at 3.3 billion Dollars annually. "We have estimated, crudely, that the economic burden for pressure ulcers is similar to diabetes. It is absolutely enormous," said Krahn.; Source: University of Toronto

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