Abstract
In 2008, WHO already considered wounds and all related problems as a new hidden epidemic, affecting millions of people around the world. Due to its high prevalence, 1 to 2% in developed countries, it constitutes a public health problem and still, today, a challenge for healthcare professionals, but above all a heavy burden for healthcare systems. In Portugal it is estimated that there are 3.3 people with wounds per thousand inhabitants.
On the other hand, it is known that 70% of these users are followed in the community.
Until now, there were no integrated and differentiated responses available at the Portuguese NHS.
As a result of the training activity and acquisition of professional skills in the area of tissue viability and wound treatment, 3 nurses submitted an application for international certification to the Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas, in 2022. It was the starting point for planning and implementing a differentiated and proximity response.
We identify other valuable hospital's human resources, such as nutritionist, psychologist, orthopedist or social service technician for a multidisciplinary response. We held several meetings with the Board of Directors to define the necessary spaces, processes and equipment. We visited all primary care and 3rd sector units to disseminate the project. In the Execution phase, we monitored the gradual increase in referrals with readjustment of opening hours. The implementation process was progressive and continuous, taking into account people's nosological reality with wounds. In the Control phase, carried out quarterly, it was necessary to readjust the referral criteria (from 6 to 10 weeks) so that primary care teams could refer the most complex cases.
In 2023, around 1600 treatments were carried out. Discharge rate is 65%. 76% of referred users come from Primary Care. The treatment of each user from hospitalization to clinical discharge cost, on average, €807.83. There was a median of 7 weeks of treatment until clinical discharge. This was the organizational unit with the highest number of compliments recorded at the Hospital.
With this health response, it has been possible to closely monitor the population with stagnant chronic injuries. In parallel, interdisciplinarity allows the evaluation and treatment of other comorbidities. As a team with specific knowledge in the area, it is possible to reduce healing times and refer appropriately to other differentiated services. This is an opportunity for a clear improvement in healthcare provided in the context of Local Health Units.
The sustainability of the project will be guaranteed by the relationship of trust established between the LHU Board of Directors, CWU health professionals, primary healthcare and patients. The proximity of care allows greater user confidence, facilitating continuous monitoring, promoting adherence to treatment, significantly improving clinical results and satisfaction levels.
With the creation of Coimbra LHU, in 2024, we will now expand the activity of Cantanhede’s CWU, with a total of 5 specialized units in more distant locations and get closer to the populations, promoting improved accessibility and the reduction of global costs.