Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral

Robert Mclafferty, Gary L. Dunnington, Mark A. Mattos, Stephen J. Markwell, Don E. Ramsey, John P. Henretta, Laura A. Karch, Kim J. Hodgson, David S. Sumner

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: Many new patients evaluated by vascular surgeons are referred by internal medicine physicians (IMPs). Objectives shared by vascular surgeons and IMPs include early identification of peripheral arterial disease (PAD), improved referral relationships, and reduction of health care costs. The approach to PAD by IMPS and identification of deficiencies that might contribute to suboptimal care form the basis for this report. Methods: An anonymous survey was mailed to all IMPs (n = 843) in the central and southern parts of Illinois. Questions concerned IMP demographics, approach to diagnostic testing, referral patterns, perception of adequacy of education of PAD, and how often parts of the history and physical examination for PAD would be performed on the initial office visit of a hypothetical 65-year-old male with hypertension (each answer measured as 0%-25%, 25%-50%, 50%-75%, and 75%-100% of the time completed). Results: There was a response from 360 IMPs: 230 IMPs (27.3%) returned the questionnaire, and 130 IMPs (15.4%) declined to participate. Practice locations for IMPs returning the questionnaire included rural (36%), suburban (22%), and urban (40%). Practice types included academic (7%), solo private (29%), group private (53%), and other (14%). A history of cardiac disease was obtained most of the time by 92% of IMPs (75%- 100% answer category). Histories for pulmonary disease, diabetes mellitus, stroke, and smoking were obtained most of the time with similar frequencies (85%, 86%, 73%, and 96%, respectively). In contrast, only 37% obtained a history for claudication, and 26% obtained a history for foot ulceration 75% to 100% of the time (P <.05, all comparisons). Examination of the heart (95%) and lungs (96%) occurred most of the time (75%-100% answer category) compared with each part of the pulse examination (range, 34%-60%; P <.05, all comparisons) and aortic aneurysm palpation (39%; P <.05). If pedal pulses were absent, examination by IMPs with Doppler scan and ankle-arm indices were mostly distributed in the 0% to 25% answer category (79% and 79%, respectively). After suspecting PAD, most IMPs obtained diagnostic tests first compared with specialist referral: carotid disease (91% vs 9%), aortic aneurysm (91% vs 9%), and lower extremity PAD (86% vs 14%). Initial referral patterns were made to vascular surgeons (49%), general surgeons (33%), cardiothoracic surgeons (13%), cardiologists (4%), and radiologists (1%). Most IMPs believed medical school (70%) and residency (73%) provided adequate training for PAD diagnosis. Conclusions: Deficiencies may exist in the identification of PAD by IMPs that could adversely affect diagnosis, time to referral, health care costs, and ultimately, patient outcome. Improvements in medical school education and IMP training in the diagnosis of PAD are needed.

Original languageEnglish (US)
Pages (from-to)870-879
Number of pages10
JournalJournal of Vascular Surgery
Volume31
Issue number5
StatePublished - May 2000
Externally publishedYes

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Peripheral Vascular Diseases
Internal Medicine
Blood Vessels
Referral and Consultation
Peripheral Arterial Disease
Physicians
Aortic Aneurysm
History
Medical Schools
Health Care Costs
Foot
Office Visits
Palpation
Internship and Residency
Medical Education
Cardiology
Routine Diagnostic Tests
Ankle
Lung Diseases
Physical Examination

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mclafferty, R., Dunnington, G. L., Mattos, M. A., Markwell, S. J., Ramsey, D. E., Henretta, J. P., ... Sumner, D. S. (2000). Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. Journal of Vascular Surgery, 31(5), 870-879.

Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. / Mclafferty, Robert; Dunnington, Gary L.; Mattos, Mark A.; Markwell, Stephen J.; Ramsey, Don E.; Henretta, John P.; Karch, Laura A.; Hodgson, Kim J.; Sumner, David S.

In: Journal of Vascular Surgery, Vol. 31, No. 5, 05.2000, p. 870-879.

Research output: Contribution to journalArticle

Mclafferty, R, Dunnington, GL, Mattos, MA, Markwell, SJ, Ramsey, DE, Henretta, JP, Karch, LA, Hodgson, KJ & Sumner, DS 2000, 'Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral', Journal of Vascular Surgery, vol. 31, no. 5, pp. 870-879.
Mclafferty R, Dunnington GL, Mattos MA, Markwell SJ, Ramsey DE, Henretta JP et al. Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. Journal of Vascular Surgery. 2000 May;31(5):870-879.
Mclafferty, Robert ; Dunnington, Gary L. ; Mattos, Mark A. ; Markwell, Stephen J. ; Ramsey, Don E. ; Henretta, John P. ; Karch, Laura A. ; Hodgson, Kim J. ; Sumner, David S. / Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. In: Journal of Vascular Surgery. 2000 ; Vol. 31, No. 5. pp. 870-879.
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abstract = "Objective: Many new patients evaluated by vascular surgeons are referred by internal medicine physicians (IMPs). Objectives shared by vascular surgeons and IMPs include early identification of peripheral arterial disease (PAD), improved referral relationships, and reduction of health care costs. The approach to PAD by IMPS and identification of deficiencies that might contribute to suboptimal care form the basis for this report. Methods: An anonymous survey was mailed to all IMPs (n = 843) in the central and southern parts of Illinois. Questions concerned IMP demographics, approach to diagnostic testing, referral patterns, perception of adequacy of education of PAD, and how often parts of the history and physical examination for PAD would be performed on the initial office visit of a hypothetical 65-year-old male with hypertension (each answer measured as 0{\%}-25{\%}, 25{\%}-50{\%}, 50{\%}-75{\%}, and 75{\%}-100{\%} of the time completed). Results: There was a response from 360 IMPs: 230 IMPs (27.3{\%}) returned the questionnaire, and 130 IMPs (15.4{\%}) declined to participate. Practice locations for IMPs returning the questionnaire included rural (36{\%}), suburban (22{\%}), and urban (40{\%}). Practice types included academic (7{\%}), solo private (29{\%}), group private (53{\%}), and other (14{\%}). A history of cardiac disease was obtained most of the time by 92{\%} of IMPs (75{\%}- 100{\%} answer category). Histories for pulmonary disease, diabetes mellitus, stroke, and smoking were obtained most of the time with similar frequencies (85{\%}, 86{\%}, 73{\%}, and 96{\%}, respectively). In contrast, only 37{\%} obtained a history for claudication, and 26{\%} obtained a history for foot ulceration 75{\%} to 100{\%} of the time (P <.05, all comparisons). Examination of the heart (95{\%}) and lungs (96{\%}) occurred most of the time (75{\%}-100{\%} answer category) compared with each part of the pulse examination (range, 34{\%}-60{\%}; P <.05, all comparisons) and aortic aneurysm palpation (39{\%}; P <.05). If pedal pulses were absent, examination by IMPs with Doppler scan and ankle-arm indices were mostly distributed in the 0{\%} to 25{\%} answer category (79{\%} and 79{\%}, respectively). After suspecting PAD, most IMPs obtained diagnostic tests first compared with specialist referral: carotid disease (91{\%} vs 9{\%}), aortic aneurysm (91{\%} vs 9{\%}), and lower extremity PAD (86{\%} vs 14{\%}). Initial referral patterns were made to vascular surgeons (49{\%}), general surgeons (33{\%}), cardiothoracic surgeons (13{\%}), cardiologists (4{\%}), and radiologists (1{\%}). Most IMPs believed medical school (70{\%}) and residency (73{\%}) provided adequate training for PAD diagnosis. Conclusions: Deficiencies may exist in the identification of PAD by IMPs that could adversely affect diagnosis, time to referral, health care costs, and ultimately, patient outcome. Improvements in medical school education and IMP training in the diagnosis of PAD are needed.",
author = "Robert Mclafferty and Dunnington, {Gary L.} and Mattos, {Mark A.} and Markwell, {Stephen J.} and Ramsey, {Don E.} and Henretta, {John P.} and Karch, {Laura A.} and Hodgson, {Kim J.} and Sumner, {David S.}",
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T1 - Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral

AU - Mclafferty, Robert

AU - Dunnington, Gary L.

AU - Mattos, Mark A.

AU - Markwell, Stephen J.

AU - Ramsey, Don E.

AU - Henretta, John P.

AU - Karch, Laura A.

AU - Hodgson, Kim J.

AU - Sumner, David S.

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N2 - Objective: Many new patients evaluated by vascular surgeons are referred by internal medicine physicians (IMPs). Objectives shared by vascular surgeons and IMPs include early identification of peripheral arterial disease (PAD), improved referral relationships, and reduction of health care costs. The approach to PAD by IMPS and identification of deficiencies that might contribute to suboptimal care form the basis for this report. Methods: An anonymous survey was mailed to all IMPs (n = 843) in the central and southern parts of Illinois. Questions concerned IMP demographics, approach to diagnostic testing, referral patterns, perception of adequacy of education of PAD, and how often parts of the history and physical examination for PAD would be performed on the initial office visit of a hypothetical 65-year-old male with hypertension (each answer measured as 0%-25%, 25%-50%, 50%-75%, and 75%-100% of the time completed). Results: There was a response from 360 IMPs: 230 IMPs (27.3%) returned the questionnaire, and 130 IMPs (15.4%) declined to participate. Practice locations for IMPs returning the questionnaire included rural (36%), suburban (22%), and urban (40%). Practice types included academic (7%), solo private (29%), group private (53%), and other (14%). A history of cardiac disease was obtained most of the time by 92% of IMPs (75%- 100% answer category). Histories for pulmonary disease, diabetes mellitus, stroke, and smoking were obtained most of the time with similar frequencies (85%, 86%, 73%, and 96%, respectively). In contrast, only 37% obtained a history for claudication, and 26% obtained a history for foot ulceration 75% to 100% of the time (P <.05, all comparisons). Examination of the heart (95%) and lungs (96%) occurred most of the time (75%-100% answer category) compared with each part of the pulse examination (range, 34%-60%; P <.05, all comparisons) and aortic aneurysm palpation (39%; P <.05). If pedal pulses were absent, examination by IMPs with Doppler scan and ankle-arm indices were mostly distributed in the 0% to 25% answer category (79% and 79%, respectively). After suspecting PAD, most IMPs obtained diagnostic tests first compared with specialist referral: carotid disease (91% vs 9%), aortic aneurysm (91% vs 9%), and lower extremity PAD (86% vs 14%). Initial referral patterns were made to vascular surgeons (49%), general surgeons (33%), cardiothoracic surgeons (13%), cardiologists (4%), and radiologists (1%). Most IMPs believed medical school (70%) and residency (73%) provided adequate training for PAD diagnosis. Conclusions: Deficiencies may exist in the identification of PAD by IMPs that could adversely affect diagnosis, time to referral, health care costs, and ultimately, patient outcome. Improvements in medical school education and IMP training in the diagnosis of PAD are needed.

AB - Objective: Many new patients evaluated by vascular surgeons are referred by internal medicine physicians (IMPs). Objectives shared by vascular surgeons and IMPs include early identification of peripheral arterial disease (PAD), improved referral relationships, and reduction of health care costs. The approach to PAD by IMPS and identification of deficiencies that might contribute to suboptimal care form the basis for this report. Methods: An anonymous survey was mailed to all IMPs (n = 843) in the central and southern parts of Illinois. Questions concerned IMP demographics, approach to diagnostic testing, referral patterns, perception of adequacy of education of PAD, and how often parts of the history and physical examination for PAD would be performed on the initial office visit of a hypothetical 65-year-old male with hypertension (each answer measured as 0%-25%, 25%-50%, 50%-75%, and 75%-100% of the time completed). Results: There was a response from 360 IMPs: 230 IMPs (27.3%) returned the questionnaire, and 130 IMPs (15.4%) declined to participate. Practice locations for IMPs returning the questionnaire included rural (36%), suburban (22%), and urban (40%). Practice types included academic (7%), solo private (29%), group private (53%), and other (14%). A history of cardiac disease was obtained most of the time by 92% of IMPs (75%- 100% answer category). Histories for pulmonary disease, diabetes mellitus, stroke, and smoking were obtained most of the time with similar frequencies (85%, 86%, 73%, and 96%, respectively). In contrast, only 37% obtained a history for claudication, and 26% obtained a history for foot ulceration 75% to 100% of the time (P <.05, all comparisons). Examination of the heart (95%) and lungs (96%) occurred most of the time (75%-100% answer category) compared with each part of the pulse examination (range, 34%-60%; P <.05, all comparisons) and aortic aneurysm palpation (39%; P <.05). If pedal pulses were absent, examination by IMPs with Doppler scan and ankle-arm indices were mostly distributed in the 0% to 25% answer category (79% and 79%, respectively). After suspecting PAD, most IMPs obtained diagnostic tests first compared with specialist referral: carotid disease (91% vs 9%), aortic aneurysm (91% vs 9%), and lower extremity PAD (86% vs 14%). Initial referral patterns were made to vascular surgeons (49%), general surgeons (33%), cardiothoracic surgeons (13%), cardiologists (4%), and radiologists (1%). Most IMPs believed medical school (70%) and residency (73%) provided adequate training for PAD diagnosis. Conclusions: Deficiencies may exist in the identification of PAD by IMPs that could adversely affect diagnosis, time to referral, health care costs, and ultimately, patient outcome. Improvements in medical school education and IMP training in the diagnosis of PAD are needed.

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