(CR-053) Clinical Outcomes and Access Barriers in Under-Resourced Populations Receiving Nurse Practitioner–Led Wound Care

Dilek Yilmaz Akyaz, RN, Msc, PhD(c) – Graduate School of Health Sciences, Koç University; Oleg Teleten, MS, RN, CWCN – UC Davis Medical Center; Jeff Souza, DNP, FNP – Active Life Wound Clinic; Holly Kirkland-Kyhn, PhD, FNP-c, GNP-c, CWCN, FAANP – Uc Davis, Betty Irene School Of Nursıng

Introduction:

Chronic wounds pose a major clinical and public health challenge, particularly among under-resourced populations facing substantial barriers to healthcare access. Disrupted continuity of care, unstable living conditions, transportation difficulties, and fragmented follow-up contribute to delayed healing and preventable complications. Although nurse practitioner–led wound care has shown promising outcomes, evidence on wound characteristics, access barriers, and healing outcomes in under-resourced populations remains limited. This study examined wound types, barriers to care, and healing outcomes among under-resourced individuals receiving care in a nurse practitioner–led wound clinic.

Methods:

A retrospective cohort study was conducted using electronic health records from a nurse practitioner–led wound care clinic between 2020 and 2024. Patients with chronic wounds who received ongoing wound care follow-up were included (n = 493). Data on wound types, care engagement, access barriers, and healing outcomes were analyzed. Barriers to care were categorized based on documented patterns of missed contact, nonattendance, care refusal, or referral outside the clinic. Descriptive and comparative analyses were performed to examine wound characteristics and clinical outcomes.

Results:

The mean patient age was 58.5±16.0 years. The most common wound diagnoses were non-pressure chronic ulcers (17.6%), unspecified open wounds (17.4%), and pressure injuries (16.6%). Overall, 91.9% of patients achieved wound healing, while 6.8% had unresolved wounds. Only 58.4% of patients were successfully examined in clinic. Major barriers to care included unreachable contact (17.0%), missed appointments (15.4%), and refusal of care (5.7%). Referral source was not significantly associated with clinic visit completion (p = 0.26). Strong correlations were observed between treatment duration, number of visits, and follow-up period.

Discussion:

Despite significant access barriers, high healing rates were achieved among under-resourced individuals who engaged in nurse practitioner–led wound care. These findings highlight the importance of continuity and sustained follow-up and underscore the need for flexible, community-based and remote strategies to overcome persistent access barriers, improve care engagement, and enhance long-term wound outcomes across vulnerable populations. Such approaches may reduce preventable complications, decrease emergency service utilization, and support more equitable delivery of chronic wound care.