Introduction

Even before the onset of COVID-19 and certainly since, health care facilities have faced challenges related to resources, staffing, and infection control.¹ However, telehealth resources can aid across the care continuum. These resources can facilitate patient data dissemination to the multidisciplinary team. For example, a telehealth encounter may help determine the need for an in-person appointment, thus minimizing the amount of travel required by staff and patients to uphold a certain level of care. Mobile technology can also involve patients in their care in new and innovative ways, potentially increasing adherence and optimizing wound care outcomes in the face of evolving obstacles.

The Stalled Patient Engagement Trajectory

It’s not just chronic wounds that stall during the healing trajectory. Patient engagement can stall, too, leading to wound care fatigue for the patient. The link between psychosocial factors and wound healing has long been recognized.² These roadblocks on the patient engagement trajectory could potentially initiate a vicious cycle of nonadherence to wound care, poor healing outcomes, and impacts on mental health, as well. If a patient expresses disengagement, how can clinicians spark their interest? How can wound care professionals help lead patients from despair to hope? The use of mobile technology is one option that could facilitate this transition from passivity to partnership in wound care.

Mobile Technology in Overcoming Patient Engagement Barriers

Patient expectations: Chronic and hard-to-heal wounds require long and often complex courses of treatment. Patients may not be prepared for this reality and may misinterpret slow healing as failure to heal. They can lose trust in wound care professionals and the wound care process when they don’t quickly see results. Certain treatments, such as debridement or dressing changes, may be painful, and aging patients may have comorbidities or cognitive impairment that complicate wound healing and management. Patient education is key, and mobile technology can provide teaching tools for patients across outpatient settings to better understand their wound and track its healing progress.³The patient-provider relationship: A patient's lack of trust may reflect a feeling of helplessness, and a patient who doesn't trust the clinician may be less likely to adhere to the wound care plan. Empowering patients as an equal partner in their care is important because both the patient and provider are actively engaged in their wound care, and adherence to treatment will come more naturally. Mobile technology can reinforce this collaboration by giving the patient ways to document and monitor wound healing autonomously and to share that information with the multidisciplinary team. Wound care systems and dressings: Some wound care protocols and dressings, especially advanced wound care systems, are difficult for patients and their caregivers to manage and may require extra training. These supplies may not be affordable or readily accessible. It is likely wise to speak with the patient and/or caregivers to find appropriate wound care supplies and techniques that may be more comfortable or cost-effective. During telehealth visits, clinicians can offer real-time reassurance and guidance while a patient performs dressing changes and other wound care protocols.

Mobile Technology in Facilitating Patient Engagement

Mobile technology has advanced with the increase in chronic and nonhealing wounds,⁴ and has transformed wound care. Technological advances that enable providers and patients to identify and monitor the progress of wounds may also help patients feel hopeful about their healing process. In the clinic, the mobile devices used in initial and ongoing wound assessments may provide accurate measurements and detailed photographs of wound healing in action that can be shared with patients.⁵ At home, patients can follow subtle wound changes and may be encouraged by each small improvement.² Mobile technology can also be used to prevent wounds. For example, a study in patients with diabetes found that diabetic foot ulcers were prevented, and patient engagement was increased through a protocol combining the use of a mobile app with patient education.⁶

Telehealth

Many patients unable to access in-person wound care services can benefit from telehealth.^4,7 These patients may not have available or affordable transportation to in-person appointments. Some patients may not feel well enough to leave their homes, either because of the wound or because of comorbidities, including psychological, sensory, or cognitive issues. Another consideration is the prevention of exposure of older or otherwise immunocompromised patients to infectious pathogens, such as COVID-19. One major advantage of telehealth technology is the ability to remotely assess and track wound healing. Another advantage with a positive impact on patient engagement is the convenience of receiving professional wound care services at home, aided by digital photography and other advances.^3-5,7-8 This technology removes geographic and accessibility-related barriers to wound care, including in remote areas with limited numbers of wound care providers,⁷ and thereby opens the door to wound care in underserved populations.⁹

Barriers to the use of telehealth include the system’s technical requirements, such as reliable rural internet access, as well as any physical and cognitive impairments patients may have that would interfere with operating the telehealth system and devices. In addition, some older adults are unfamiliar or uncomfortable with medical technology and prefer in-person wound care.⁷ Telehealth requires a HIPAA-compliant video system for patient-provider communication and a camera that will allow accurate wound assessment and monitoring.⁴ It is also important to keep in mind any insurance or regulatory guidelines based on licensure, geographic location, or other factors that could impact a patient’s eligibility for telehealth services.

Digital Photography, Including “Wound Selfies”

In the clinic, digital devices used in initial and ongoing wound assessments can provide measurements of a wound’s dimensions and also photos of the wound's healing progress that can be shared across the multidisciplinary team as well as patients.¹⁰ Some of these devices can be portable and noncontact devices, which may assist those patients with potential mobility issues. In the comfort of their home, patients can regularly take and upload “wound selfies” from a smartphone.¹¹ These photographs show subtle, incremental changes in the wound as it heals and alert clinicians to signs of infection or nonhealing. For documentation purposes, these images are valuable additions to the patient’s electronic medical record. A study conducted by the American College of Surgeons found that patients and their caregivers were willing and able to monitor surgical wounds remotely by using digital "wound selfies," These photographs aided in detecting and intervening in wound complications as well as keeping patients engaged in their care.¹²

Conclusion

The trajectory of patient engagement is essential to optimize wound care outcomes. Mobile technology can help patients become more active participants in their care and thus enhance adherence to wound care plans.

References

1. Grabowski DC, Mor V. Nursing Home Care in Crisis in the Wake of COVID-19. JAMA. 2020;324(1):23–24. doi:10.1001/jama.2020.8524
2. Alexander SJ. Time to get serious about assessing - and managing - psychosocial issues associated with chronic wounds. Curr Opin Support Palliat Care. 2013;7(1):95-100.
3. Patient engagement: encouraging healing by involving patients in wound care. Practice Accelerator blog. WoundSource 2022. Accessed January 5, 2023. https://www.woundsource.com/blog/patient-engagement-encouraging-healing…
4. Practice Accelerator blog. What’s new in wound care? WoundSource.com. Published May 31, 2022. Accessed December 29, 2022. https://www.woundsource.com/blog/what-s-new-in-wound-care
5. Shamloul N, Ghias MH, Khachemoune A. The utility of smartphone applications and technology in wound healing. Int J Low Extrem Wounds. 2019;18:228-235.
6. Kilic M, Karadağ A. Developing and evaluating a mobile foot care application for persons with diabetes mellitus: a randomized pilot study. Wound Manag Prev. 2020;66(10):29–40.
7. Gajarawala SN, Pelkowski JN. Telehealth benefits and barriers. J Nurse Pract. 2021;17(2):218-221.
8. Monshipouri M, Aliahmad B, Ogrin R, et al. Thermal imaging potential and limitations to predict healing of venous leg ulcers. Sci Rep. 2021;11(1):13239.
9. Ensuring equity of wound care through technology. Practice Accelerator blog. WoundSource.com. 2022. Accessed December 29, 2022. https://www.woundsource.com/blog/ensuring-equity-wound-care-through-tec…
10. Using wound photos to enhance your documentation. Practice Accelerator blog. WoundSource.com. Published January 31, 2021. Accessed January 5, 2023. https://www.woundsource.com/blog/using-wound-photos-enhance-your-docume…
11. Webb R. Remote monitoring-the rise of the wound selfie. J Wound Care. 2018;27(3):117.
12. Gunter RL, Fernandes-Taylor S, Rahman S, et al. Feasibility of an image-based mobile health protocol for postoperative wound monitoring. J Am Coll Surg. 2018;226(3):277-286.