Costs of treating skin lesions in Primary Health Care

Received: 19 Nov 2019 | Accepted: 12 Dec 2019 ABSTRACT Objective: To compare the cost of dressing with the use of conventional and advanced dressings in Primary Health Care. Method: Retrospective longitudinal study conducted in a municipality in the interior of Minas Gerais, Brazil, which followed 15 patients from admission to the healing of skin lesions to calculate treatment costs. Previous treatment up to the time of admission to the study was compared by processing the time and materials spent with the current treatment with advanced coverage. Results: In the conventional treatment, the average time of existence of the lesion before admission in the study was 620 days. The estimated total cost of all patients with daily change of conventional dressing was R$ 101,030.58 (US$ 26,586.94). In the advanced coverage treatment modality, the average follow-up time was 151 days, resulting in a total cost of R$ 15,631.02 (US$ 4,113.43). The savings were over R$ 85,000.00 (US$ 22,370.00). Conclusion: The cost of treatment with advanced coverages was seven times lower for the municipality, in addition to reducing the healing time for patients, allowing a shorter return to their work activities.


INTRODUCTION
The skin lesion is characterized by rupture of tissue integrity, which leads to changes in anatomical and physiological functions of affected tissues 1  Several products are available for the treatment of skin lesions, which, with the technology employed and advances in the mode of action, allow them to be called advanced covers. These dressings are interactive, allow the maintenance of the temperature near the body temperature, promote the impermeability, and help the angiogenesis, favoring, this way, the healing process 6 .
The different characteristics of lesions and the variable therapeutic response require that health professionals, especially the nurse, can argue with public managers about the variety of covers and the cost-effectiveness of their use. It should be noted that in Brazil, it is still common to use conventional products that require daily changes in dressings. In this sense, the evaluation of advanced covers costs compared to conventional ones can subsidize the managers' decision for the best therapeutic method for the treatment of skin lesions in PHC.
From this context, the objective of this study was to compare the cost of the performance of dressings with the use of conventional and advanced covers in PHC.

METHODS
This is a retrospective longitudinal study using information from medical records of people with skin lesions.
Dressings with conventional covers were considered those that use only gauze, 0.9% saline solution (SS), procedure gloves, bandage, and some kind of dailychange ointment. The dressings with advanced covers were those that use besides gauze, SS 0.9% and procedure gloves, interactive covers such as hydrocolloid, calcium alginate, polyurethane foam, among others that allow change with less frequency.
The study was conducted in a Basic Health Unit of a municipality of 230,000 inhabitants located in the Midwest of Minas Gerais, Brazil, based on a research project that aimed at implementing the use of these covers as a function of cost analysis.
Costs of treating skin lesions in Primary Health Care

DISCUSSION
The participants in the research were mostly elderly, with an average age of 66 years. It is known that aging is associated with decreased skin elasticity and vascularization, which favors the appearance of injury. At the same time, with tissue alterations typical of aging, the older person is more prone to comorbidities, immobility, and malnutrition 2,3 .
The proportion of males is slightly higher than females, which shows a small difference in the incidence The choice and access to advanced covers allow for less frequent dressing changes that benefit the patient with accelerated healing, reduced pain, exudate, and odor 10,11 .
Another aspect is that the nurse gets free time for other activities, besides getting the discharge for cure with less time 12

CONCLUSION
The cost of treatment with advanced covers was approximately seven times lower when compared to the modality with conventional covers, representing a saving of more than R$ 85,000.00 (US$ 22,370.00) for the municipality. It should be noted that the treatment time in the modality with advanced covers is shorter than the dressing with conventional covers and allows patients to return to their work activities more quickly. This therapeutic option also provides higher availability of time for professionals, since the dressings are not performed daily, which further increases savings to the public coffers. The results of this study subsidize the decision of municipal management to adopt more effective and less expensive practices in the care of people with skin lesions.