Abstract
BackgroundPatients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. If diagnosed early, cardiovascular risk factors can be treated and the risk of other cardiovascular diseases can be reduced. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients.AimTo identify the issues for primary care health professionals (HPs) and patients in PAD diagnosis and management, and to explore the impact of these on HPs and PAD patients.Design & settingQualitative study conducted in a primary care setting in the North East of England. Data was collected between December 2014 and July 2017.MethodSemi-structured interviews and focus groups were conducted with PAD register patients (n = 17), practice nurses ([PNs], n = 17), district nurses (DNs], n = 20), tissue viability nurses (n = 21), and GPs (n = 21).ResultsHPs’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis. Some HPs had a reactive approach to PAD identification. Patients lacked understanding about PAD and some reported a delay consulting their GP after the onset of PAD symptoms. After diagnosis, few were attending for regular GP follow-up.ConclusionPatient education about PAD symptoms and risks, and questioning about exercise tolerance, could address the problem of under-reporting. Annual reviews could provide an opportunity to probe for PAD symptoms and highlight those requiring further investigation. Improved information when PAD is diagnosed and, considering the propensity for patients to tolerate worsening symptoms, the introduction of annual follow-up (at minimum) is warranted.
Highlights
A diagnosis of peripheral arterial disease (PAD) indicates an increased risk of coronary heart disease, stroke, and heart attack.[1]
health professionals (HPs)’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis
Patients from the PAD register (the National Institute for Health and Care Excellence (NICE) Quality and Outcomes Framework (QOF) Indicator states that general practices should establish and maintain a register of patients with PAD) and PNs from the practices participating in the diagnostic study
Summary
A diagnosis of PAD indicates an increased risk of coronary heart disease, stroke, and heart attack.[1] Symptoms include intermittent claudication, which is calf pain on walking. There is evidence of low compliance with PAD management guidelines such as lipid[6] and blood pressure control.[7] Supervised exercise is recommended for all patients,[5] but very few UK clinical commissioning groups provide this service.[8] Patients with mild PAD should be managed in primary care; if the condition worsens or does not resolve, or if there are problems with diagnosis, they should be referred to secondary care.[5]. Patients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients
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