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The Burden of Venous Leg Ulcers and Limited Health Literacy

By Bernard Ross, CEO and founder, Sky Medical Technology

By Bernard Ross, CEO and founder, Sky Medical Technology

Successful medical recovery often relies on a patient’s ability to independently manage and actively improve their own health condition. Being able to do this effectively requires an adequate level of health literacy (HL) – the ability to understand and act on healthcare advice to help oneself recover effectively.

Patient HL is defined by the Health Resources & Services Administration as ‘the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment’. As an exmple, someone with low patient HL could find it difficult to read and comprehend instructions for taking antibiotics, and subsequently take the medication incorrectly.

Low HL is a global issue that affects people from all backgrounds, though it is thought that older people, and those with limited education, lower income, or chronic conditions, are more likely to struggle with health literacy.

Many people do not have the appropriate knowledge, understanding or confidence to navigate healthcare information and services. Approximately 80 million adults in the US are thought to have limited or low HL and is particularly prominent in adults above the age of 65, who are four times more likely to have limited functional HL than other age groups.

Combined risks hindering patient outcomes

Older age groups are also at a higher risk of developing chronic wounds, including venous leg ulcers (VLU). VLUs are skin ulcers that affect the gaiter area and are largely caused by continuous venous hypertension or chronic venous insufficiency. VLUs are common – affecting up to three percent of the global population – and risk increases with age where prevalence doubles among those older than 65.

In the US, three percent of adults above the age of 65 suffer from chronic wounds, including predominantly venous stasis ulcers, pressure ulcers (bedsores), and diabetic foot ulcers. Chronic wounds affect up to 6.5 million people in the US. Financially, the annual cost of treating venous ulcers alone in the US is approximately $3 billion a year, making wound treatment a large-scale, time-consuming, and expensive medical issue.

Standard of care (SoC) for VLU can vary across healthcare systems, though it typically recommends compression therapy and exercise. Specific clinical recommendations for treating VLUs can be challenging for some patients to understand, especially those required to treat their wounds independently at home – which has become increasingly common during the Covid-19 pandemic. Self-management of VLUs could therefore be particularly challenging for patients with limited HL who must treat VLUs at home, increasing the risk of wounds worsening or healing at a slower rate.

The burden of VLU

VLUs take months to heal, while many never heal at all. Even if a wound has healed, the chance of recurrence is high. It is therefore essential for healthcare professionals and patients to collaborate to ensure the recommended care is completely understood and having a positive impact.

Increased blood flow to the wound surface has been clinically proven to promote wound healing in VLUs, enhancing venous return and preventing venous stasis. Current SoC recommends the use of compression therapy, which is usually applied below the knee to increase blood flow to the gaiter area. Increased exercise also promotes blood flow and is recommended by healthcare professionals, but clearly this may be challenging for patients that are elderly or immobile. Patient understanding of and adherence to the VLU management recommendations can be less than optimal, due to HL issues or immobility.

VLU-specific HL can impact patient outcomes by affecting the adoption of positive health behaviours. Higher HL enables patients to better understand the benefits of adhering to VLU self-management recommendations and can make adopting healthy behaviours – in line with an agreed plan – more achievable. For example, patients with low HL may have a poorer comprehension of comfort when choosing compression bandaging subsequently hindering the effectiveness of compression treatment. Similarly, such patients may have limited bandage application skills due to difficulties understanding guidelines and instructions.

Pandemic-accelerated change

Treatment of VLUs (and many other conditions) has become increasingly difficult during the pandemic; hospitals have been at full capacity and several wards deemed ‘non-essential’ have closed. This has left many patients independently managing health conditions.

Many patients living with VLUs have had to relocate treatment into the home setting, including compression therapy management, changing dressings, and exercising. This pandemic-accelerated change, derived from an overstretched primary care resource, has shifted VLU care to teleconsultation. However, this relies on patient self-management and has further increased patient isolation, negatively impacting compression adherence, concordance and patient well-being. For patients with limited HL this can lead to high levels of non-compliance and consequent slowing of healing.

The new era of telemedicine and digital care could be a lasting change. Therefore, innovative medical interventions are required to make independent care simpler, more achievable, and more accessible, particularly for those with limited HL.

Intervention of innovation

An area well equipped to address issues with HL and improve VLU care is medical technology (MedTech). Increasingly, MedTech devices are designed with self-medication in mind – they are easy for patients to use and improve levels of medical compliance in the home setting, even for those with lower levels of HL.

For example, a device that is clinically proven to promote blood flow could have a role in the treatment of VLU. To enable patients to use it independently, the device needs to be safe, quick and easy to administer, and come with clear and concise instructions written in simple language with supporting illustrations. Such devices can work alongside or instead of the current SoC, and potentially offer more cost-effective treatment options.

Devices that are suitable for patients with low or limited HL enable increased adherence and concordance to VLU recommendations. This would give those patients independently managing VLUs a better chance of recovering quickly and effectively and reduce the chance of a VLU recurrence.

Making healthcare fair

Covid-19 has caused a backlog in routine operations and limited other forms of long-term care, increasing medical demand that clinicians and other healthcare professionals simply cannot sustain using the resources currently available.

For most patients suffering with ongoing health issues, it is unlikely that time will heal their wounds – some form of professional clinical support will be required to improve their conditions. Medical resources are in short supply and medical staff are overworked leaving many patients suffering with limited mobility and/or extreme pain while waiting for treatment and advice. For patients with VLU, wounds are at risk of worsening and independent management is critical for healing. But not all patients have the health literacy skills to adhere with treatment and guidance.

Telecommunications and digital health are helping to bridge the gap between accessibility and recovery by saving healthcare systems money, resources and – crucially – time, while giving patients more opportunities to find medical help. This is especially important for patients with low health literacy and VLU, who may struggle to positively improve their conditions on their own.

About the author: Bernard Ross is CEO and founder of Sky Medical Technology (Sky). Sky creates world-leading medical devices that saves lives while saving healthcare systems money. Sky’s biomedical devices use its proprietary bio-electronic nerve stimulation technology – OnPulse™ – clinically proven to increase blood circulation in the deep veins of the calf. The result is the company’s multi-award-winning device, the geko™ – a wristwatch-sized wearable applied to the knee delivering painless electrical impulses to stimulate blood flow, without the patient having to move. It has been globally adopted into healthcare systems to treat a range of medical conditions including the prevention of venous thromboembolism and the treatment and prevention of oedema (swelling).

Bernard is a serial entrepreneur with more than 20 years’ senior experience at private and public board level across multiple industries including pharmaceutical, technology development and FMCG. Bernard is a former Head of International Development at CMI plc, Senior Vice President, Cardiovascular of Bioaccelerate Inc. (BACL) and former CEO of Innacardio Inc.


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