Peripheral arterial disease diagnosis and management in primary care: a qualitative study

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.

Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

“…Institutional barriers in particular (eg, a lack of training groups and primary health care providers providing care to patients with PAD) limit the likelihood of an adequate health care offer for affected patients. Previous studies already reported the undersupply of primary health care for patients with PAD in general as well as those from various sociodemographic backgrounds [ 24 , 25 ].…”

Nurses’ and patients’ experiences and preferences of the ankle-brachial pressure index and multi-site photoplethysmography for the diagnosis of peripheral arterial disease: A qualitative study

“…Whilst there is evidence that invasive tests can impact on patient acceptance and participation, specifically when associated with pain and discomfort [38], there is a need for further research to usefully explore the meanings and experiences of patients undergoing routine non-invasive tests in primary care, especially where mild pain or discomfort is possible. This is of particular relevance for PAD, the symptoms of which are already under-reported [6, 7], and which could be influenced by test anxiety.…”

“…PAD is a global health problem, affecting around one in five people aged over 60 years [4]. People with PAD have been identified to have a significantly lower quality of life and high levels of pain [5], although PAD is often under-reported, under-diagnosed and sub-optimally treated [6, 7]. More specifically, the majority of people with PAD are asymptomatic [4] despite similar levels of mortality to symptomatic patients [8], and many of those patients who are symptomatic do not present to their general practitioner or other healthcare professional due to a lack of knowledge about PAD [9].…”

The Frequency of Primary Healthcare Contacts Preceding the Diagnosis of Lower-Extremity Arterial Disease: Do Women Consult General Practice Differently?

“…The GP is the first person to intervene at the early symptoms of LEAD [11,12]. Nonetheless, it remains unclear whether differences in severity, delays in diagnosis, and differences in prognosis between women and men might be caused, potentially due to delays, in the early stages at the GP level.…”