The role of the general practitioner and vascular surgeon in the treatment of patients with peripheral artery disease
ClaudicatioNet is a national network of specialized physiotherapists, that is committed to a ‘stepped care approach’ in the treatment of patients with peripheral artery disease (PAD). This approach ensures that patients will only receive a more invasive treatment (i.e. percutaneous transluminal angioplasty or surgical bypass) if necessary. Therefore, according to the guidelines, all PAD patients should start with a program of supervised exercise therapy (SET) and lifestyle counselling guided by a certified ClaudicatioNet physiotherapist. SET is a proven effective treatment for PAD. Invasive treatment should only be considered if the results of the SET program are insufficient or if symptoms (severely) increase.
In general, a PAD patient is referred for a SET program by a general practitioner or a medical specialist. According to the guidelines, general practitioners should refer PAD patients to a certified ClaudicatioNet therapist. In daily practice, however, patients are still primarily referred to the hospital. One of the main obstacles for general practitioners in following the guidelines is the low incidence of patients with PAD (approximately 5 patients per year per general practice) and unfamiliarity about ClaudicatioNet physiotherapists. ClaudicatioNet aims to have patients treated in first-line care (such as general practitioners and physiotherapists) as much as possible, which will result in reduced healthcare costs and a lowered risk of invasive treatment at an early stage.
Since January 2017, one complete treatment program is reimbursed through basic insurance. This means that every patient that is diagnosed with intermittent claudication (Fontaine 2) is entitled to a SET program of 12 months consisting of 37 treatment sessions, on the condition that the physiotherapist providing the SET program is a certified member of ClaudicatioNet. All associated therapists can easily be found on the digital ‘care finder’ and referrals can be made through the ‘Digital Referral’ application.
A SET program (including lifestyle counselling) is often a very intensive process for the patient. Motivation and self-management are strongly associated to disease insight and expectation management. Therefore, it is sensible to inform patients about extra available information. ClaudicatioNet has a special website (www.etalagebenen.nl), a Facebook page, and brochure for this purpose (in Dutch). The Dutch patient association for cardiovascular diseases (Harteraad) additionally supports patients by e.g. introducing fellow patients.