What role do comorbidities play in the management of chronic wounds in primary care?

Comorbidities play a critical role in the management of chronic wounds in primary care by influencing both the assessment and treatment strategies. Chronic wounds, such as diabetic foot ulcers, often coexist with other long-term conditions like diabetes, cardiovascular disease, and multimorbidity, which complicate wound healing and require a holistic, individualized approach to care ¹,³.

In primary care, recognising and managing comorbidities is essential to optimise wound healing outcomes. For example, diabetic foot ulcers necessitate assessment not only of the wound itself but also of underlying conditions such as peripheral arterial disease and neuropathy, which are common comorbidities that affect healing and infection risk ¹. Additionally, patients with chronic wounds frequently have multimorbidity, defined as two or more long-term health conditions, which may include physical and mental health disorders, frailty, and sensory impairments. This complexity demands a personalised management plan that balances wound care with the treatment burden and potential drug interactions arising from multiple conditions and medications ³.

Effective management involves comprehensive assessment of the wound and the patient’s overall health status, including frailty and polypharmacy, to reduce adverse events and unplanned care. Coordination across services and shared decision-making with the patient about their health priorities and treatment preferences are key components of this approach ³. For instance, in diabetic foot ulcer care, offloading, infection control, and wound debridement must be integrated with cardiovascular risk management and glycaemic control to address the broader health context ¹.

Furthermore, the presence of comorbidities influences the choice of wound dressings and interventions, aiming to minimise treatment burden and optimise cost-effectiveness while considering patient preference ¹. Pain management in chronic wounds, which may be exacerbated by comorbid conditions, also requires tailored topical interventions to improve quality of life (Ffrench et al., 2023).

In summary, comorbidities necessitate a multifaceted, patient-centred approach in primary care chronic wound management, focusing on comprehensive assessment, individualised care planning, coordination, and integration of wound-specific and systemic treatments to improve healing and quality of life ¹,³(Ffrench et al., 2023).