In the United States, only about 25% of the general population is aware of peripheral arterial disease (PAD), a strikingly low percentage considering that the disease impacts an estimated 8 to 12 million Americans. Studies show that many cases of PAD go undiagnosed each year, reflecting that management of the disease remains suboptimal. Increasing physician awareness and adherence to guideline recommendations could potentially reduce the high rate of mortality and morbidity seen with PAD.
Primary care physicians (PCPs) play an extremely critical role in the early diagnosis of PAD, often serving as the first point of contact for patients suffering from its symptoms. Unfortunately, time is at a premium for these general practitioners; they face increasing patient demands and greater time constraints, making it challenging for them to always give enough attention to holistic health issues. Simple PAD warning signs (eg, leg cramping or pain) are frequently attributed to other common, more benign, factors. Complicating matters is that about half of people with PAD do not show any major symptoms at all. As such, the partnership between PCPs and vascular surgeons is essential to making a swift diagnosis and developing an effective treatment plan. We owe it to each other and our patients to educate and collaborate as we care for PAD patients.
Making a Concerted Effort
My colleagues and I are committed to this partnership. Our vascular surgeons work closely with the PCPs throughout our network to identify PAD risk factors and symptoms as early as possible so that we can collaboratively determine the best course of treatment. To enhance this partnership, we’ve enabled real-time communication between providers by using our electronic medical record system. This technology gives PCPs the opportunity to ask vascular surgeons any relevant patient questions. They receive a rather immediate answer or recommendation. Experience has proven that the system is quick, efficient, and enables a full review of all pertinent testing that is being performed.
In another effort to improve access to patients and their PCPs, my colleagues and I see patients at six regional hospitals. This allows us to communicate regularly with PCPs at the local level and build relationships with them. We can also help raise awareness of PAD symptoms and risk factors so that diagnoses are not missed and proper referrals are made. While this is not always an option, it behooves PCPs and patients to institute such practices whenever possible.
A “Cross-Training” Education
It’s important to take a “cross training” approach with PCPs early on in their medical education. For example, every Monday, primary care residents from a local primary care training program spend the morning in the vascular clinic seeing patients with PAD with me and my colleagues. The goal of this experience is for trainees to gain a better understanding of the presentation, diagnosis, and treatment of PAD. Ideally, this type of cross training will help our PCPs in diagnosing the disease timely and effectively. With the right processes in place and regular communication, together, we can ensure that our patients receive the proper care, with an eye toward early detection and intervention. Our patients’ well-being depends on it.
Readings & Resources (click to view)
Rooke TW, Hirsch AT, Sanjay M, et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guideline. J Am Coll Cardiol. 2011;58:2020-2045. Available at: http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.08.023v1.
Saljoughian M. PAD: millions undiagnosed or untreated. US Pharm. 2012;37:HS16-HS18. Available at: http://www.uspharmacist.com/content/d/in-service/c/33097.
American Heart Association. About peripheral arterial disease (PAD). Available at: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/About-Peripheral-Artery-Disease-PAD_UCM_301301_Article.jsp.
Lacroix P, Aboyans V, Voronin D, et al. High prevalence of undiagnosed patients with peripheral arterial disease in patients hospitalised for non-vascular disorders. Int J Clin Pract. 2008;62:59-64.
Fintel DJ. The burden of PAD: diagnosis and contemporary medical management through risk-factor modification. Internet J Cardiol. 2009;6:2. Available at: http://www.ispub.com/journal/the-internet-journal-of-cardiology/volume-6-number-2/the-burden-of-pad-diagnosis-and-contemporary-medical-management-through-risk-factor-modification.html#sthash.MMMmhtDz.dpbs.
Arain FA, Cooper LT Jr. Peripheral arterial disease: diagnosis and management. Mayo Clin Proc. 2008;83:944-949.