The legs for life screening for peripheral vascular disease: Compliance with physician recommendations in moderate- and high-risk assessed patients

PURPOSE: To determine compliance within a community with recommendations ma de by physicians during the 1999 Legs for Life National Screening for Perip heral Vascular Disease (PVD) and Leg Pain. MATERIALS AND METHODS: Patients were initially screened for PVD by completi on of the Legs for Life risk factor questionnaire and determination of bila teral ankle/brachial indexes (ABIs). Each patient subsequently met with an interventional radiologist or vascular surgeon. Patients with normal ABIs ( >1.0 bilaterally) or mildly abnormal ABI(s) (<1.0 but >0.90) were classifie d at no and low risk for PVD, respectively; patients with ABI(s) of 0.70-0. 89 were classified at moderate risk for PVD; and patients with ABI(s) <0.69 were classified at high risk for PVD. Risk factors for PVD were assessed b y the consulting physician and discussed with all patients. Recommendations were made for additional evaluation and/or follow-up care, if necessary. S even months after screening, patients who were assessed at moderate and hig h risk for PVD were contacted by telephone to determine if they had pursued additional care or testing. RESULTS: A total of 205 patients were screened for PVD, 48 (23%) of whom we re determined to be at moderate to high risk. Forty-four (92%) patients wer e available for follow-up. At 7 months after screening, 31 (70%) patients h ad received no further medical advice or treatment. Thirteen (30%) of these patients had completed a follow-up appointment, but only three with a phys ician specializing in peripheral vascular disease. None of the patients had clinical follow-up with an interventional radiologist. Five (11%) patients had undergone noninvasive Doppler evaluation and one (2%) had undergone di agnostic arteriography. No patient had undergone any form of percutaneous o r surgical intervention. CONCLUSION: Patient compliance with physician recommendations after outpati ent screening for PVD is low. The Legs for Life screening program could be considered successful in that it provides far patient education and the ide ntification of moderate to high-risk patients. Physicians participating in this program may have to modify their approach to patient screening and fol low-up if a concomitant goal is to deliver specialty care.