Patient Compliance

Benjamin Franklin famously stated, “An ounce of prevention is worth a pound of cure.” This statement was made in reference to the importance of fire prevention in 18th century Philadelphia, but it aptly applies to modern diabetic limb salvage. The multidisciplinary model for amputation prevention has been in place now for almost two decades, but how far have we really come? Recent literature suggests that there has not been a significant decline in reamputation rates for diabetic patients despite the team approach to care. Diabetes is a complex and aggressive disease that affects multiple organ systems and robs patients of sight, sensation, limb, and quality of life. Treating such an aggressive disease is challenging, to say the least, and often the desired outcome is not achieved.

About 89 percent of people who come to doctors’ offices have already Googled their symptoms, notes D. Scott Covington, MD, FACS, CWSP. He says most patients wanted to see how serious their health condition was before going to an actual doctor. “They’re armed with misinformation. They’re really on the wrong path,” Dr. Covington told the audience at his presentation at the Symposium on Advanced Wound Care (SAWC) Fall.

May is Mental Health Awareness Month and with the staggering statistics of one in four adults living with mental illness, I immediately was motivated to write a personal blog. I previously shared my son’s experience here in 2020, in “Wound Management Challenges in Prison Populations,” and discussed the importance of establishing a quality of wound care. I started thinking about the high number of incarcerated people with mental health issues, and it prompted me to conduct a bit more research. Given my son's dual diagnosis of schizophrenia and post-traumatic stress disorder (PTSD), I recall having a conversation with him during this time about debridement methods because advanced wound care would become extremely complicated. I immediately started educating him on possible dressings and debridement methods that could be used on his wound. This gave him an idea of what to expect and allowed him to decline certain treatments if he so preferred.

Maria Goddard, MD, CWS, FAPWCA began by pointing out that there are differences in the health care space when discussing compliance versus adherence. The phenomenon of patients not following medical advice is not new, but it has significant ramifications on morbidity and mortality.

An important step in wound management is identifying wound etiology. Pinpointing the problem often helps guide patient treatment. Identifying the cause of the wound, employing evidence-based interventions, and initiating an appropriate topical therapy will help to stabilize and, oftentimes, heal the wound. However, the decisions patients make on a daily basis, along with activities (time spent in bed, chair, with legs dependent, etc), have a significant impact on healing outcomes, independent of the wound care professional. Patient-centered education is a huge piece of effective self-management and an essential component of the nursing plan of care. This blog will focus on the importance of initial and ongoing patient-centered education in chronic wound management.