Skip to main content Accessibility help
Hostname: page-component-79b67bcb76-f4n6r Total loading time: 0.32 Render date: 2021-05-16T09:38:20.319Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }


Published online by Cambridge University Press:  29 October 2018

Myriam Le Goff-Pronost
IMT Atlantique (Télécom Bretagne),
Bénédicte Mourgeon
réseau TELAP
Jean-Pierre Blanchère
réseau TELAP
Luc Teot
CHU Montpellier, réseau Cicat LR
Hervé Benateau
chirurgie maxillo-faciale CHU
Anne Dompmartin
Caen University Hospital Center



Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home.


The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months.


We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations.


Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p < .05). The percentage of wounds completely healed was not statistically different between the telemedicine and control group (66 percent versus 61 percent; p > .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months.


This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.

Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below.


We thank the funders of the study: the French digital health agency ASIP Santé; the Regional Health Agency (ARS) of Basse-Normandie; the ARS of Languedoc-Roussillon; and the healthcare cooperation consortium GCS e-health. We also thank the Regional Directorate of Health Insurance of Rouen, in particular Dr. Kuhn, and all health professionals and patients of TELAP network who participated in the trial. No conflicts of interest.


1.Graham, I, Harrison, M, Nelson, E, Lorimer, K, Fisher, A. Prevalence of lower-limb ulceration: A systematic review of prevalence studies. Adv Skin Wound Care. 2003;16:305316.CrossRefGoogle ScholarPubMed
2.Järbrink, K, Ni, G, Sönnergren, H, et al. Prevalence and incidence of chronic wounds and related complications: A protocol for a systematic review. Syst Rev. 2016;5:152.CrossRefGoogle ScholarPubMed
3.Gottrup, F. A specialized wound-healing center concept: Importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds. Am J Surg. 2004;187:38S43S.CrossRefGoogle ScholarPubMed
4.Nordheim, LV, Haavind, MT, Iversen, MM. Effect of telemedicine follow-up care of leg and foot ulcers: A systematic review. BMC Health Serv. Res 2014;14:565.CrossRefGoogle ScholarPubMed
5.Tricco, AC, Antony, J, Vafei, A, et al. Seeking effective interventions to treat complex wounds: An overview of systematic reviews. BMC Med. 2015;13:223.Google ScholarPubMed
6.Tricco, AC, Cogo, E, Isaranuwatchai, W, et al. A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types. BMC Med. 2015;13:90.CrossRefGoogle ScholarPubMed
7.Wicke, C, Bachinger, A, Coerper, S, et al. Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized wound care center. Wound Repair Regen. 2009;17:2533.CrossRefGoogle Scholar
8.Gorecki, C, Brown, JM, Nelson, EA, et al. European Quality of Life Pressure Ulcer Project group. Impact of pressure ulcers on quality of life in older patients: A systematic review. J Am Geriatr Soc. 2009;57:1175e83.CrossRefGoogle ScholarPubMed
9.Guest, JF, Ayoub, N, McIlwraith, T, et al. Health economic burden that different wound types impose on the UK's National Health Service. Int Wound J. 2017;14:322330.CrossRefGoogle ScholarPubMed
10.Kolltveit, B, Gjengedal, E, Graue, M, et al. Telemedicine in diabetes foot care delivery: Health care professionals’ experience. BMC Health Serv. Res 2016;16:134.CrossRefGoogle ScholarPubMed
11.Sood, A, Granick, MS, Trial, C, et al. The role of telemedicine in wound care: A review and analysis of a database of 5,795 patients from a mobile wound-healing center in Languedoc-Roussillon, France. Plast Reconstr Surg. 2016;138:248S256S.CrossRefGoogle ScholarPubMed
12.Chanussot-Deprez, C, Contreras-Ruiz, J. Telemedicine in wound care: A review. Adv Skin Wound Care. 2013;26:7882.CrossRefGoogle ScholarPubMed
13.Bergmo, TS. How to measure costs and benefits of eHealth interventions: An overview of methods and frameworks. J Med Internet Res. 2015;17:11.CrossRefGoogle ScholarPubMed
14.Arora, M, Harvey, LA, Glinsky, JV, et al. Cost-effectiveness analysis of telephone-based support for the management of pressure ulcers in people with spinal cord injury in India and Bangladesh. Spinal Cord. 2017;55:1071.CrossRefGoogle ScholarPubMed
15.Stern, A, Mitsakakis, N, Paulden, M, et al. Pressure ulcer multidisciplinary teams via telemedicine: A pragmatic cluster randomized stepped wedge trial in long term care. BMC Health Serv Res. 2014;14:83.CrossRefGoogle ScholarPubMed
16.Fasterholdt, I, Gerstrøm, M, Rasmussen, BSB, et al. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients. Health Informatics J. 2018;24:245258.CrossRefGoogle ScholarPubMed
17.HAS, Haute Autorité de Santé. Dressings: Indications and recommended uses. Leaflet on good practice in health care technology use, 2011, Paris: HAS.Google Scholar
18.Makady, A, de Boer, A, Hillege, H, Klungel, O, Goettsch, W. What is real -world data? A review of definitions based on literature and stakeholder interviews. Value Health. 2017;20:858865.CrossRefGoogle Scholar
19.Terry, M, Halstead, LS, O'Hare, P, et al. Feasibility study of home care wound management using telemedicine. Adv Skin Wound Care. 2009;22:358364.CrossRefGoogle ScholarPubMed
20.Jelnes, R. Telemedicine in the management of patients with chronic wounds. J Wound Care. 2011;20:187190.CrossRefGoogle ScholarPubMed
21.Rees, RS, Bashshur, N. The effects of TeleWound management on use of service and financial outcomes. Telemed J E Health. 2007;13:663674.CrossRefGoogle ScholarPubMed
22.Wootton, R, Bahaadinbeigy, K, Hailey, D. Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: Proposal for quantitative synthesis in a systematic review. BMC Health Serv Res. 2011;11:185.CrossRefGoogle ScholarPubMed
23.Rodrigues, JJ, Pedro, LM, Vardasca, T, de la Torre-Díez, I, Martins, HM. Mobile health platform for pressure ulcer monitoring with electronic health record integration. Health Informatics J. 2013;19:300311.CrossRefGoogle ScholarPubMed
24.Wiseman, JT, Fernandes-Taylor, S, Barnes, ML, et al. Conceptualizing smartphone use in outpatient wound assessment: Patients’ and caregivers’ willingness to use technology. J Surg Res. 2015;198:245251.CrossRefGoogle ScholarPubMed
25.Zarchi, K, Haugaard, VB, Dufour, DN, Jemec, GB. Expert advice provided through telemedicine improves healing of chronic wounds: Prospective cluster controlled study. J Invest Dermatol. 2015;135:895900.CrossRefGoogle ScholarPubMed
26.Ameen, J, Coll, AM, Peters, M. Impact of tele-advice on community nurses' knowledge of venous leg ulcer care. Adv Nurs. 2005;50:583594.CrossRefGoogle ScholarPubMed
Supplementary material: File

Le Goff-Pronost et al. supplementary material

Figure S1

Download Le Goff-Pronost et al. supplementary material(File)
File 33 KB

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *