Morrozoff William G
Aspen University, Phoenix, AZ, United States.
J Vasc Nurs. 2024 Dec;42(4):270-275. doi: 10.1016/j.jvn.2024.09.002. Epub 2024 Sep 24.
Peripheral artery disease (PAD) affects more than 8 million individuals in the United States and many patients diagnosed with PAD are not receiving supervised exercise therapy which considered first line therapy in a program of comprehensive evidence-based care. This lack of evidence-based therapy can lead to reduced functional status, limited mobility, poor quality of life, and contribute to escalating healthcare costs in the population of patients with symptomatic peripheral artery disease.
An analysis conducted on the current treatment practices for patients with symptomatic PAD by practitioners at a private cardiology group practice in Eastern North Carolina revealed that supervised exercise therapy (SET) was not prescribed for their population of patients with PAD. The absence of an evidence-based guideline-directed SET protocol partnered with no operating vascular wellness program created variations in the treatment of patients diagnosed with symptomatic PAD. These variations can impact the quality of care delivery and outcomes of individuals diagnosed with PAD. The main purpose of this quality improvement project was to evaluate provider support in adopting an evidence-based SET protocol into current treatment practices of individuals with symptomatic PAD. This quality improvement initiative is relevant to other clinical venues as it may further define the role of gaining provider support through formal evaluative instruments of patient protocols such as SET to increase availability, access, and referrals of patients needing healthcare services.
A quality improvement initiative was implemented to determine if the practitioners in a private cardiology group practice in Eastern North Carolina would support the adoption of an evidence-based SET protocol into their current treatment practices for individuals with symptomatic PAD. Through the utilization of the best empirical evidence, a protocol for SET was developed. The SET protocol was then appraised by the private cardiology group practitioners using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.
The utilization of the AGREE II tool by the cardiology practitioners demonstrated that the evidence-based SET protocol quality rating scores in all six domains were greater than seventy percent. All providers supported the recommended SET protocol using the AGREE II instrument (n = 5, 100%).
Success in provider support for the adoption of a SET protocol was the result of cardiology practitioners' appraisal of the evidence and vision to reduce the variation in current treatment practices of patients with symptomatic PAD. More investigation is needed across various healthcare systems to further evaluate provider support of SET protocols to further reduce variation in the treatment of patients with symptomatic PAD.
外周动脉疾病（PAD）在美国影响着超过800万人，许多被诊断为PAD的患者未接受被视为综合循证护理项目一线治疗的监督运动疗法。这种缺乏循证治疗的情况会导致功能状态下降、活动受限、生活质量差，并导致有症状外周动脉疾病患者群体的医疗成本不断攀升。
对北卡罗来纳州东部一家私人心脏病学集团诊所的从业者针对有症状PAD患者的当前治疗实践进行的一项分析显示，他们并未为其PAD患者群体开具监督运动疗法（SET）。缺乏循证指南指导的SET方案，再加上没有运营中的血管健康项目，导致被诊断为有症状PAD患者的治疗存在差异。这些差异会影响护理质量以及被诊断为PAD患者的治疗结果。这个质量改进项目的主要目的是评估在将循证SET方案纳入有症状PAD患者的当前治疗实践中时提供者的支持情况。这项质量改进举措与其他临床场所相关，因为它可能会进一步明确通过诸如SET等患者方案的正式评估工具获得提供者支持的作用，以增加需要医疗服务患者的可及性、就诊机会和转诊率。
实施了一项质量改进举措，以确定北卡罗来纳州东部一家私人心脏病学集团诊所的从业者是否会支持将循证SET方案纳入他们对有症状PAD患者的当前治疗实践中。通过利用最佳实证证据，制定了SET方案。然后，私人心脏病学集团的从业者使用《研究与评价指南评估II》（AGREE II）工具对SET方案进行评估。
心脏病学从业者使用AGREE II工具表明，循证SET方案在所有六个领域的质量评级得分均超过70%。所有提供者都使用AGREE II工具支持推荐的SET方案（n = 5，100%）。
提供者支持采用SET方案取得成功是心脏病学从业者对证据进行评估以及希望减少有症状PAD患者当前治疗实践差异的愿景的结果。需要在各种医疗系统中进行更多调查，以进一步评估提供者对SET方案的支持，从而进一步减少有症状PAD患者治疗中的差异。
