Diagnosis of peripheral arterial disease in primary care: a survey of general practitioners in England & Ireland

Talk Code: 
D.9
Presenter: 
Judit Konya
Co-authors: 
STJ McDonagh, G Abel, K Boddy, CE Clark
Author institutions: 
Primary Care Research Group, University of Exeter Medical School

Problem

Lower extremity peripheral arterial disease (PAD) has a global prevalence of 10%. PAD is associated with reduced quality of life and physical functioning, and may lead to critical limb ischaemia, limb loss or death. PAD represents a substantial economic and health care burden and is under-diagnosed, perhaps due to variability of leg symptoms presented. The EuroPAD group comprises PAD guideline authors, vascular and primary care experts from 10 European countries. This group conceived and developed a survey for a Europe-wide assessment of current primary care approaches to detecting and monitoring PAD.This study seeks to understand general practitioners’ (GPs) usual approaches to the diagnosis, assessment and follow-up of PAD in England and the Republic of Ireland (ROI), using an online, country-specific, version of the EuroPAD survey. We will compare aggregated responses with current standards and guidelines, explore trends in responses according to practice demographics, and link responses to current Quality and Outcomes Framework (QOF) indicator achievements for PAD, to describe factors associated with high or low-level achievement.

Approach

The online survey is currently being distributed via email to GPs using various means: the local Clinical Research Network (CRN), newsletters for Royal College of General Practitioners (RCGP) Faculties (in England and ROI), Local Medical Committees and the RCGP Rural Forum Google Group.Responses will be summarised as either mean and standard deviations, or median and inter-quartile ranges according to normality of the data. Demographic and QOF characteristics of responding and non-responding practices will be compared using t-tests, Mann-Whitney or χ2 tests, as appropriate. QOF data will be compared with survey responses using Pearson’s correlation coefficients or t-tests for unadjusted comparisons, and adjusted for practice-level demographics using mixed effects logistic regression.We aim to obtain 300 responses, which will give 90% power (p<0.05) to detect a difference of 3.5% between QOF reporting of anti-platelet prescribing as one indicator of care.

Findings

The survey opened in January 2020. We aim to finish data collection by April 2020. The results from this ongoing survey will be presented at the conference.

Consequences

Our findings will offer insight into current PAD management in English and Irish primary care settings. These results will be merged with other national surveys led by the EuroPAD investigators and contribute to a Europe-wide report that can guide future policy. The results will provide an evidence base to inform the design of future interventions with the aim of improving approaches to diagnosing and monitoring PAD. We will discuss our findings with our Patient Participation (PPI) Group prior to dissemination to ensure that interpretation and presentation of results are meaningful to service users.

Submitted by: 
Judit Konya
Funding acknowledgement: 
This research was funded by the Scientific Foundation Board of the Royal College of General Practitioners(Grant No SFB 2019-24).