The Legs For Life (R) Screening for Peripheral Vascular Disease: Results of a prospective study designed to improve patient compliance with physicianrecommendations

PURPOSE: To determine how compliance with recommendations made by physician s during the 2000 Legs For Life((R)), National Screening for Peripheral Vas cular Disease (PVD) and Leg Pain is affected through the use of G) simple a nd concise patient information and recommendation cards and (ii) a "targete d" postscreening follow-up plan. MATERIALS AND METHODS: Patients were initially screened for PVD by completi on of the Legs For Life((R)) Risk Factor Assessment form and determination of bilateral anklel brachial indexes (ABIs). Each patient then met with an interventional radiologist or vascular surgeon. Patients with normal ABIs ( <1.0 bilaterally) or mildly abnormal ABIs (<1.0 but >0.90) were classified as having no risk and low risk, respectively. Patients with ABIs of 0.70-0. 89 were classified as having moderate risk for PVD and patients with ABIs < 0.69 were classified as having high risk for PVD. Physicians reviewed the R isk Factor Assessment form with each patient and made specific lifestyle im provement recommendations. For the year 2000 screening, patients classified at moderate and high risk for PVD received special instructions and a card containing clearly printed information on the purpose of the Legs For Life ((R))) screening, their level of risk for PVD, specific recommendations for follow-up, and phone numbers to call to help arrange for that follow-up. T wo weeks after the screening, a second copy of this card was mailed to each moderate- and high-risk assessed patient. Four months later, each of these patients was contacted by telephone to determine if they had pursued addit ional care or testing. RESULTS: A total of 185 patients were screened, 42 (23%) of whom were deter mined to be at moderate or high risk for PVD. Four months after the screeni ng, 39 (93%) of these patients were available for follow-up. Twenty (51%) p atients had received no further medical advice or treatment. Nineteen (49%) patients had pursued further medical care which included physician consult ation (n = 19; 100%), noninvasive Doppler evaluation (n = 10; 26%), diagnos tic arteriography (n = 2; 5%), initiation of pharmacologic therapy for clau dication (n = 1; 3%), percutaneous intervention (n = 1; 3%), or vascular su rgery (n = 1; 3%). Seventeen of 39 patients (44%) reported that claudicatio n-type leg pain was still a concern and/or lifestyle-limiting problem. CONCLUSION: Patients can be provided with problem-focused information and s uccinct physician recommendations at and soon after a screening for PVD, wh ich can contribute to enhanced patient compliance. However, a host of perso nal, social, health, and physician-related issues still prevent a large per centage of patients from achieving relief of PVD-associated leg pain.