Management of cardiovascular risk factors by primary care physicians in patients with peripheral arterial disease

D'souza, Janita R. T.; Patel, Niravkumar; Rocker, Michael; Townsend, Elaine; Morris‐Stiff, Gareth; Magee, T.R.; Galland, R. B.; Lewis, M. H.

doi:10.1016/s1479-666x(08)80109-6

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…It found that, while most patients were given advice concerning smoking cessation and blood pressure, fewer than half were given advice about weight loss or exercise. The second study 304 looked specifically at the treatment received by patients who presented with either peripheral arterial disease alone or peripheral arterial disease and CVD. It found that those patients who had peripheral arterial disease alone were given suboptimal care.…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

View full text Add to dashboard Cite

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“…20 This also implies that patients with peripheral vascular disease, even in the absence of symptomatic cardiovascular disease, require treatment of cardiovascular risk factors. 21 The patency rates in this series were superior to those in the meta-analyses for iliac 11 and femoropopliteal disease. 12,13 In the current series, the only factor associated with a poorer post-angioplasty patency was the indication for angioplasty, with critical ischaemia being associated with a poorer outcome.…”

Section: -14mentioning

confidence: 53%

Long-term clinical outcome following lower limb arterial angioplasty

Morris‐Stiff

Moawad

Appleton

et al. 2011

annals

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INTRODUCTION The aim of this study was to determine the clinical outcome of lower limb arterial angioplasty in a busy district general hospital practice. PATIENTS AND METHODS All angioplasties performed from January 1999 to December 2004 were identified and data collected included cardiovascular risk factors, indications for and complications of angioplasty, limb salvage and patient survival rates, and clinically significant re-stenoses. RESULTS 471 interventions were performed in 385 patients (231 men, 154 women). The median age was 67.9 years (range: 39-93 years). Indications for angioplasty were critical ischaemia (n=247, 52%) and lifestyle-limiting intermittent claudication (n=224, 48%). Stenotic lesions accounted for 378 (80%) cases and occlusion for 93 (20%). Radiological success was obtained in 417 (88.5%), improving to 93.6% if only those in whom access was achieved were included. Post-angioplasty complications were observed in 42/471 (9.1%) of interventions. The actual patient survival at 1,2, and 3 years was 87.4%, 85.1% and 83.2% respectively. Indication for angioplasty and the number of lesions present were identified as risk factors for outcome on multivariate analysis. The cumulative post-angioplasty patency rates at 1, 2 and 3 years were 86.0%, 83.1% and 81.6% respectively. The only factor associated with patency was the mode of presentation. CONCLUSIONS Angioplasty for lower limb peripheral vascular disease can be performed safely and efficaciously with a high technical success rate and a low complication rate. The patient survival and post-angioplasty patency data reflect the progressive and multi-site nature of the underlying disease process.

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“…Primary care's challenge is to encourage patients to respond to the risk factors we already have instead of adding others' (27). Souza et al (31) showed recently how PAD treatment alone was still sub-optimally treated, while Gandey in 2009 (32) reported that a third of patients still did not tell of claudication symptoms and half of GP's did not ask.…”

mentioning

confidence: 99%

Problem solved: erectile dysfunction (ED) = early death (ED)

Jackson¹

2010

International Journal of Clinical Practice

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Management of cardiovascular risk factors by primary care physicians in patients with peripheral arterial disease

Cited by 7 publications

References 14 publications

The organisation and delivery of health improvement in general practice and primary care: a scoping study

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Long-term clinical outcome following lower limb arterial angioplasty

Problem solved: erectile dysfunction (ED) = early death (ED)

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