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

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 therefore represents a substantial economic and health care burden. The condition is under-diagnosed, perhaps due to the 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 and follow-up of PAD in England, using an online, country-specific, version of the EuroPAD survey.

We aim to survey the current practices of GPs in England in suspecting, assessing and diagnosing PAD. 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 will be distributed via email to GPs using various means: the local Clinical Research Network (CRN), newsletters for Royal College of General Practitioners (RCGP) Faculties, Local Medical Committees and the RCGP Rural Forum Google Group. Postal reminders may also be distributed. We aim to finish data collection by March 2020.

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 will open in November 2019; analyses and results will be presented at the conference.

Consequences

Our findings will offer insight into current PAD management in English 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.