Letter to: Effectiveness of Continuous Home Wound Care on Patients With Diabetic Foot Ulcers

I read with great interest the recent study of continuous home wound care for patients with diabetic foot ulcers (DFUs), which provides valuable insights into post-discharge management Luo (2024). The results suggest that home wound care, guided by the HBCCM model, is non-inferior to routine outpatient care in terms of ulcer healing. In addition, it demonstrates potential economic benefits by reducing medical costs. However, while the study provides significant contributions, I believe that further research and refinement are needed in several areas to fully understand the implications and optimise the intervention.

The study highlights the critical role of self-management behaviours in wound care, especially for DFU patients who face both physical and financial burdens. While the intervention improved self-management by providing targeted education on foot care and early warning signs of ulcer deterioration, the lack of patient knowledge remains a key barrier to effective self-care. Patients' lack of understanding of early signs of deterioration and their misconceptions about the severity of DFUs may prevent timely intervention, leading to delayed healing or complications. In addition, the study's reliance on multimedia education, such as animated videos and educational materials, appears to be an innovative approach. However, the challenge of ensuring that such interventions reach all patient populations—especially those in rural or low-resource settings—remains. Future studies could further explore the effectiveness of these educational tools in different demographic groups and assess whether personalised or culturally tailored educational approaches could improve patient understanding and engagement in self-care practices. In addition, the study could explore the impact of integrating telehealth or mobile health platforms that allow for real-time monitoring and support, which would address potential gaps in care delivery, particularly for those with limited access to healthcare professionals.

Another critical aspect of the study is the variation in the effectiveness of home wound care based on the severity of the DFU. The finding that home wound care was less effective for patients with Wagner Grade III ulcers raises concerns about the feasibility of this approach for more complex cases. Although the study provides evidence to support the use of home wound care for mild to moderate ulcers, it suggests that severe ulcers may require more intensive, hospital-based treatment. The potential for infection, improper dressing changes and delayed healing due to inadequate home care highlights the limitations of relying solely on family caregivers for more advanced ulcers. This raises important questions about the scalability of home care interventions for all DFU patients, especially those with more severe disease. Future research could investigate how best to manage advanced DFUs in the home setting, such as by involving professional wound care nurses or by integrating specialised wound care technologies. In addition, the study's stratification of ulcer healing time by Wagner grade Liu (2024) and baseline ulcer area could be expanded to include a broader range of ulcer classifications to provide a more nuanced understanding of when and for whom home care is truly effective.

In addition, while the study's economic analysis suggests potential cost savings from reduced outpatient visits, it does not fully capture the broader financial impact of home wound care. The study focuses on direct medical costs, such as treatment and dressings, but does not include indirect costs, such as transportation, caregiver time and potential long-term care needs that may arise from complications. These factors can significantly alter the cost-effectiveness of the intervention, particularly in populations with limited financial resources. Future studies should aim to conduct more comprehensive economic evaluations that include both direct and indirect costs. It would be particularly useful to consider a cost–benefit analysis from a societal perspective, taking into account the long-term savings that could result from fewer hospital admissions, fewer amputations and improved quality of life for patients who experience better wound healing outcomes. In addition, exploring the cost-effectiveness of incorporating telehealth services or other remote monitoring solutions could help further reduce costs while maintaining or improving the quality of care.

Finally, the study highlights the importance of family caregivers to the success of home wound care. While family involvement is essential, the study's reliance on caregiver training raises questions about the sustainability of such an approach, particularly in low-income or rural areas where access to educational resources may be limited Jewell (2024). Although caregiver training materials were provided, the complexity of DFU care and the potential for caregiver fatigue or inadequacy should not be underestimated. More research is needed to explore how to improve caregiver support, perhaps by incorporating peer support networks, community health workers or mobile health tools that provide ongoing guidance and encouragement. In addition, the role of telehealth in ensuring that caregivers receive real-time feedback and professional supervision could further enhance the success of home care interventions, especially for patients with more complex or high-risk ulcers.

In conclusion, while this study provides promising evidence for the efficacy of continuous home wound care in the management of DFUs, a deeper exploration of its limitations and the broader context in which it is applied is needed. Addressing the challenges of patient education, management of severe ulcers, cost-effectiveness and caregiver support will be essential to optimise this intervention and make it a viable option for all DFU patients, regardless of their severity or socioeconomic status.