In summary, patient referral delays and lack of early
detection of PUP in Thailand are important weaknesses with
poor clinical outcomes. Severe PUP requires improved care
management, avoidance of unnecessary medical treatment,
and proper referral of patients. The referral system in Thailand
may need revising. In addition, the findings of this study are
useful for doctors and nurses in clinical practice in developing
countries for early detection and treatment of PUP.