Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care
Open accessAbstract
BACKGROUND: The study was conducted to determine the clinical and cost effectiveness of enhanced multi-disciplinary teams (EMDTs) vs. 'usual care' for the treatment of pressure ulcers in long term care (LTC) facilities in Ontario, Canada METHODS: We conducted a multi-method study: a pragmatic cluster randomized stepped-wedge trial, ethnographic observation and in-depth interviews, and an economic evaluation. Long term care facilities (clusters) were randomly allocated to start dates of the intervention. An advance practice nurse (APN) with expertise in skin and wound care visited intervention facilities to educate staff on pressure ulcer prevention and treatment, supported by an off-site hospital based expert multi-disciplinary wound care team via email, telephone, or video link as needed. The primary outcome was rate of reduction in pressure ulcer surface area (cm2/day) measured on before and after standard photographs by an assessor blinded to facility allocation. Secondary outcomes were time to healing, probability of healing, pressure ulcer incidence, pressure ulcer prevalence, wound pain, hospitalization, emergency department visits, utility, and cost. RESULTS: 12 of 15 eligible LTC facilities were randomly selected to participate and randomized to start date of the intervention following the stepped wedge design. 137 residents with a total of 259 pressure ulcers (stage 2 or greater) were recruited over the 17 month study period. No statistically significant differences were found between control and intervention periods on any of the primary or secondary outcomes. The economic evaluation demonstrated a mean reduction in direct care costs of $650 per resident compared to 'usual care'. The qualitative study suggested that onsite support by APN wound specialists was welcomed, and is responsible for reduced costs through discontinuation of expensive non evidence based treatments. Insufficient allocation of nursing home staff time to wound care may explain the lack of impact on healing. CONCLUSION: Enhanced multi-disciplinary wound care teams were cost effective, with most benefit through cost reduction initiated by APNs, but did not improve the treatment of pressure ulcers in nursing homes. Policy makers should consider the potential yield of strengthening evidence based primary care within LTC facilities, through outreach by APNs. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01232764.
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More complex telewoundcare management situations, such as pressure ulcers involving multiple carers, have been shown to be comparable with conventional practice.
“More complex telewoundcare management situations, such as pressure ulcers involving multiple carers, have also been shown to be comparable with conventional practice [30].”
From Recent directions in telemedicine: Review of trends in research and practice (2015) · cites this paper as [30]
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- Authors
- Stern, A., Mitsakakis, N., Paulden, M., Alibhai, S., Wong, J., Tomlinson, G., Brooker, A.-S., Krahn, M., & Zwarenstein, M.
- Affiliations
- University Health Network (CA)
- University of Toronto (CA)
- University of Alberta (CA)
- Toronto General Hospital (CA)
- Western University (CA)
- Corresponding author
- Stern, Anita
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2014-02-24
- Volume
- 14
- Issue
- 1
- Pages
- 83-83
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC4104322
- OpenAlex
- W2007166182
- Cited by
- 94
- References
- 30
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 5 · 2023: 5 · 2022: 14 · 2021: 15 · 2020: 10 · 2019: 7 · 2018: 9 · 2017: 8 · 2016: 2 · 2015: 7 · 2014: 2
- FWCI
- 19.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Funders
- Canadian Patient Safety Institute
- Topics
- Health Sciences › Health Professions › Occupational Therapy › Pressure Ulcer Prevention and Management
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Keywords
- pressure ulcers, telemedicine, long-term care facilities, nursing homes, advanced practice nurses, pressure ulcer prevention, wound healing, cost-effectiveness
- MeSH terms
- Adult, Aged, Cost-Benefit Analysis, Pressure Ulcer, Female, Health Services Research, Hospitalization, Humans, Interviews as Topic, Male, Middle Aged, Ontario, Patient Care Team, Wound Healing, Incidence, Prevalence, Cluster Analysis, Treatment Outcome, Telemedicine
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