My Scope of Practice: Advancing Wound Care in Rural Areas

Frank Aviles, PT, CWS, FACCWS, CLT has a passion for wound care and a desire to bring his skills to populations that often are underserved. He has worked hard to ensure people in rural areas receive the same level of care as their urban counterparts, and he founded (at his own expense) a professional information exchange: the Wound Care Roundtable. 

Frank graduated from Florida A&M University (Tallahassee, FL) with a Bachelor’s of Science in Physical Therapy in 1991. After graduation, he worked in a 1000-bed hospital in the Hydrotherapy Department. “I wanted to help patients heal, but my main focus was to understand why some patients were not able to make progress or even why some received amputations,” he says. Two years later, he began traveling around Florida to increase his knowledge and hands-on experience in wound care. During Frank’s travels and research, he attended different nursing-based wound care educational classes, including an early Symposium on Advanced Wound Care. “Dot Weir was my mentor through this period of my life,” Frank says. “I have known her since 1994, and she was always there for me when I had questions or just needed moral support.” He also was fortunate to meet  Joyce Rohan, PT in the course of his journey, whom he credits for guiding him toward the right wound care path. “I was employed by Joyce’s facility, Alachua General Hospital, in Gainesville, FL as a contract worker on an as-needed basis,” Frank says. “While in the inpatient/outpatient physical therapy-based wound center, I assessed patients, formulated treatment plans, and defended my conclusions and treatment selection. At night, I practically lived in the library, researching wound care articles the old fashioned way: without the Internet. Several institutions throughout Florida sought me to develop their wound care programs, and I created and ran a skin/wound care program in Pennsylvania.” 

Family responsibilities required a move to Louisiana. Changing  from specialized hospitals/clinics with numerous resources to a small rural area where most patients travel more than an hour for specialized care was an eye-opening experience; Frank relished the challenge. He earned his Certified Wound Specialist designation in 2007 from the American Board of Wound Management and wanted to share his background in physical therapy and hands-on experience applying offloading devices, providing various types of compression, debriding, optimizing wound environment, and understanding formularies and dressing selections, as well as the knowledge he gained attending conferences, with other medical professionals. He initiated an event called the Wound Care Roundtable in 2005 that in 2010 evolved to become the Wound Healing Roundtable (see Sidebar). His hope was to raise the bar of medical care and improve patient outcomes. “I created, marketed, set the agenda, chose the speakers, and prepared and hosted the Roundtables,” he says. “These events provided our audience with evidence-based information on current wound practices; it allowed people who operated in silos to communicate with each other and learn how to utilize other available resources within the limits of our area.”

The Roundtables changed Frank’s role and duties as a wound care provider. “After each Roundtable, the number of clinicians calling for advice or referrals would increase,” he says. “We used this opportunity to educate others and guide them to the appropriate resources. In this capacity, I became a patient advocate.” 

His working environment in the wound clinic also changed. “One of my roles inside and outside of the clinic is to make sure everyone is following evidence-based guidelines in a timely manner,” he says. “It’s a lot like growing a garden. You have to prepare the soil long before planting, but the time you devote will determine the success of your crop.” 

Frank became a lymphedema therapist through the Academy of Lymphatic Studies in 2010 and joined the Academy of Lymphatic Studies as a wound care instructor as well as a Manual Lymph Drainage/Complete Decongestive Therapy instructor. With this knowledge under his belt, Frank sought to establish an outpatient wound care center. 

In 2014, his 9-year dream became a reality with the help of Natchitoches Regional Medical Center (NRMC) in Natchitoches, Louisiana. Frank opened a brand new outpatient wound care and hyperbaric facility on April 22, 2015 — NRMC Comprehensive Wound Services. He serves as the Wound Care Service Line Director and a board member for the center;  his responsibilities include creating and running community outreach programs, providing education locally, and overseeing wound care services provided at the acute care hospital, wound care center, nursing home, and long-term acute care facility, along with serving on the wound care center board, guiding the physician panel, and at times utilizing his skills as a physical therapist. In addition, Frank (in his personal time) consults and treats a limited number of lymphedema patients that have problems receiving care due to transportation/medical issues.   “To solve this problem, I’m currently proposing a lymphedema center as the number of patients needing this service continues to climb far beyond the help I can offer,” he says.  

Working in a rural setting presents challenges not unlike providing care in urban areas. These include dealing with limited resources and barriers that can pose obstacles for health care providers (ie, clinicians operating in silos, poor communication between departments and practitioners, poor patient adherence to treatment, inconsistency in following evidence-based guidelines, and a difference in the knowledge and skills of clinicians throughout the system), along with geographical challenges. “We overcome these barriers as a team,” Frank says. “We had to become accountable, consistent, accept constructive criticism, and strive for optimal care. The outpatient clinic director, Jamie Fontana, and I work closely to remove each barrier. Individually, we bring different skill sets and strengths to the team, but combined we offer solutions while delivering the same messages: do no harm, follow evidence-based guidelines, and put the patient first.” Limited resources have pushed Frank and his colleagues to recruit needed specialists and develop strong working relationships with others in nearby towns. “We are now working on bringing lower extremity vascular procedures to our system to avoid having patients travel long distances for this type of care.”

Frank’s dedication to his practice has proved fruitful for himself, his community, and fellow rural health care providers in nearby areas in Louisiana. “The Wound Healing Roundtables are gaining momentum at a national level as we provide evidence-based education to the bedside clinician in an interactive manner. The purpose of these events is to educate clinicians who are unable to attend the larger conferences that require long travel times.” 

Frank also has been a member of the American Physical Therapy Association since 1990 and is a member of the Clinical Electrophysiology and Wound Management Section. Although much of Frank’s life revolves around work (he says he is “pretty much working 7 days a week and up to 18-hour  days”), he still finds time for family and a small side interest: rehabbing houses. “In essence, the amount of time devoted to learning, improving your skill set, understanding the reasons why a patient’s condition does not improve, and plainly doing the right thing is directly proportional to your outcomes,” he says of his dedication to ensuring the best care in a demanding scope of practice. 

This article was not subject to the Ostomy Wound Management peer-review process.