REAL-WORLD CLINICAL EVALUATION AND COSTS OF TELEMEDICINE FOR CHRONIC WOUND MANAGEMENT.

BACKGROUND: Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home. OBJECTIVES: The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months. METHODS: We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations. RESULTS: Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months. CONCLUSIONS: This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.

Maggot therapy for wound debridement: a randomized multicenter trial.

OBJECTIVE: To study the efficacy of bagged larvae on wound debridement compared with conventional treatment. DESIGN: Randomized, multicenter, controlled, prospective phase 3 trial with blinded assessment of outcome measures by a single observer. SETTING: Two hospital referral centers in Caen and Lyon, France. PATIENTS: Random sampling of 119 patients with a nonhealing, sloughy wound 40 cm(2) or smaller, less than 2 cm deep, and an ankle brachial index of 0.8 or higher. INTERVENTION: During a 2-week hospital stay, patients received either maggot debridement therapy (MDT) or conventional treatment. At discharge, conventional dressings were applied and a follow-up visit occurred at day 30. MAIN OUTCOME MEASURE: Percentage of slough in wounds at day 15. RESULTS: There was a significant difference between groups at day 8 (54.5% in the MDT group and 66.5% in the control group) (P = .04). The mean percentage of slough at day 15 was 55.4% in the MDT group and 53.8% in the control group (P = .78). CONCLUSIONS: Although MDT shows no significant benefit at day 15 compared with conventional treatment, debridement by MDT is significantly faster and occurs during the first week of treatment. Because there is no benefit in continuing the treatment after 1 week, another type of dressing should be used after 2 or 3 applications of MDT. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01211236.