Treating claudication in 5 words (stop smoking and keep walking) is no longer enough: an audit of risk factor management in patients prescribed exercise therapy in New Zealand.
OBJECTIVE
To assess the documentation and modification of vascular risk factors in patients with intermittent claudication enrolled in an exercise programme in Christchurch, New Zealand.


METHODS
A retrospective review of case notes of patients who presented to the vascular outpatient department with intermittent claudication and were given "Green Prescriptions" for an exercise programme was performed. Referral letters, clinic letters, vascular nurse notes, and handwritten hospital notes were searched for evidence of documentation of risk factors for atherosclerosis. Modification of these risk factors was also noted. Positive attempts at risk factor modification included starting or asking the GP to start a medication or asking the GP to assist with smoking cessation.


RESULTS
Sixty patient notes were reviewed which included 81 referral letters (66 from GPs), 118 surgeon letters/clinic notes, and 43 vascular nurse assessments. Of the 60 patients referred, risk factor documentation (positive or negative) was antiplatelet therapy (40), hypertension (48), hyperlipidaemia (39), current tobacco use (40), diabetes mellitus (37), and coronary artery disease (38). Vascular surgeons saw 58 patients and documentation was antiplatelet therapy (42), hypertension (46), hyperlipidaemia (45), current tobacco use (48), diabetes mellitus (44), and coronary artery disease (29). Attempted modification of risk factors by vascular surgeons occurred in 12 patients for antiplatelet therapy, 11 patients for lipid lowering therapy, and 10 for current smokers. Forty-three vascular nurse assessments resulted in documentation of antiplatelet therapy (0), hypertension (42), hyperlipidaemia (42), current tobacco use (43), diabetes mellitus (42), and coronary artery disease (6).


CONCLUSIONS
There is suboptimal communication of vascular risk factors by referrers to specialist vascular services. The recording and modification of risk factors for atherosclerosis in our unit compares favourably with other reported series, but improvement is needed. Furthermore, the role of clinicians with an interest in risk factor management, and patients' understanding of their vascular risk factors, needs clarification.
Christchurch Vascular Group, Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
Nadine
N
Kuiper
Malcolm
M
Gordon
Justin
J
Roake
David
D
Lewis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004282:Documentation / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013041:Specialties, Nursing / Q000706:statistics & numerical data; D013043:Specialties, Surgical / Q000706:statistics & numerical data; D016138:Walking / Q000706:statistics & numerical data