Mobilising Social Care for the Family Physicians

Community resources are limited. Most are run by Voluntary Welfare Organisations that depend on subsidies from the government and funds raised from donations and activities. The out-of-pocket payment from patients depends on per capita household means testing. Patients are matched to the type of services based on their functional statuses. The tools used for functional assessments are the RAF forms and Modified Bartel Index. Applications for most of the community services are done online through the Agency of Integrated Care. Essentially, there are three types of community resources, namely financial, psychosocial, and care resources to help patients in need. To navigate this social maze, Family Physicians will need to familiarise themselves with the type of resources available, the means testing procedure, as well as the referral system. After assessing the patient’s needs and functional status, family physicians will have to match the services that can best serve their patient’s needs.

Wound Dressings: A Primer for the Family Physician

Given the myriad of choices available on the market, selecting the appropriate wound dressing remains a challenge for most healthcare workers. It is important to exercise discretion and adopt a systematic approach in dressing selection following wound assessment, as this will directly impact on rates of wound healing, which in turns affects the patient’s quality of life and overall healthcare costs. This paper provides an overview of the common types of wound dressings in use currently and gives a brief synopsis of some of the latest advances in wound care technology and their applications in management of complex wounds. The consensus to date is for the use of hydrogels in the debridement stage, foams and low-adherence dressings in the granulation stage and hydrocolloids and low-adherence dressings for the epithelialization stage. Additional studies and research need to be undertaken to further evaluate the application of advanced wound technology in clinical practice.

Wound Healing

Wound healing is achieved through four coordinated and overlapping phases, 1) haemostasis, 2) inflammatory, 3) proliferative and 4) remodelling. This complex process can be disrupted by local or systemic risk factors, resulting in delayed healing and progression to a chronic wound. Chronic wounds interact closely with a patient’s comorbid illnesses, social circumstances and functional status. The Family Physician plays an important role to optimise patient and wound risk factors that impair wound healing. Strategies to enhance wound healing include optimising local wound care based on TIME principles, identification and optimising the underlying causes for poor wound healing and education to the patients and their caregivers in wound care, dressing changes and avoidance of risk factors to prevent recurrence. Complex chronic wound care may need a multi-disciplinary approach involving allied health members to provide additional nutritional, nursing and psychosocial support. There is a role for adjuvants such as hyperbaric oxygen therapy and platelet derived growth factor gels to enhance healing in certain wounds but stronger evidence is required to support its routine use.