Creating a useful vascular center: a statewide survey of what primary care physicians really want.
OBJECTIVE
Multidisciplinary vascular centers (VCs) have been proposed to integrate vascular patient care. No studies, however, have assessed referring physician interest or which services should be provided. A statewide survey of primary care physicians (PCPs) was performed to answer these questions.


METHODS
Questionnaires were mailed to 3711 PCPs, asking about familiarity with vascular disease, potential VC usage, and services VCs should provide. Univariate and multivariate analysis was used to determine which PCPs would refer patients, the services desired, and which patients would be referred.


RESULTS
Of 1006 PCPs who responded, 66% would refer patients to a VC, especially patients younger than 50 years (P<.001) and those with lower extremity disease (P<.001) or abdominal aortic aneurysm (P<.001). PCPs practicing within 50 miles of a VC (P<.001), those in practice less than 5 years (P<.001), and those without specific training in vascular disease during residency (P=.004) were most likely to refer patients. Vascular surgery (97%), interventional radiology (90%), and a noninvasive vascular laboratory (82%) were considered the most important services, and physician educational services (62%) were also desirable. PCPs did not think cardiology, cardiac surgery, smoking cessation programs, or diabetes or lipid management are needed. Reasons for VC nonuse included travel distance (23%), sufficient local services (21%), and insurance issues (12%). Only 16% of PCPs believe that their patients with vascular disease currently receive optimal care.


CONCLUSIONS
There is considerable interest in VCs among PCPs. In contrast to recently described models, VCs need not incorporate cardiology, cardiac surgery, smoking cessation programs, or diabetes or lipid management. VCs should include vascular surgery, interventional radiology, a noninvasive vascular laboratory, and physician educational services.
Karamlou
Tara
T
Department of Vascular Surgery, Oregon Health & Sciences University, USA. karamlou@ohsu.edu
Landry
Gregory
G
Sexton
Gary
G
Chan
Benjamin
B
Moneta
Gregory
G
Taylor
Lloyd
L
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003191:Comprehensive Health Care / Q000458:organization & administration*; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment; D009922:Oregon / Q000453:epidemiology; D010348:Patient Care Team / Q000458:organization & administration; D010821:Physicians, Family / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015641:Radiography, Interventional / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014652:Vascular Diseases / Q000175:diagnosis / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data