title: [Ankle brachial index: motivations, training, and practices among 165 general practitioners in Île-de-France].
abstract: Peripheral arterial disease (PAD) is under-diagnosed despite its predictive value for cardiovascular mortality. The ankle brachial index (ABI), a simple reliable measure recommended by the French health authorities to detect and evaluate the severity of PAD, is used by too few general practitioners (GPs).
  
  
  OBJECTIVE
  This study aimed at identifying motivations and barriers for using ABI in general practice.
  
  
  METHODS
  A representative, descriptive, cross-sectional survey was conducted amongst 165 GPs practicing in Île-de-France who were interviewed using stratified quotas.
  
  
  RESULTS
  Although 1 out of 5 GPs considered ABI to be an irrelevant indicator, most had a favorable opinion about its use (OR: 4.9 [CI 95 %: 4.2-5.7]). Only 42 % (CI 95 %: 34 %-49 %) of GPs knew ABI was recommended by the health authorities. This information had a critical impact on the acceptance of ABI relevancy (OR: 3.7 [CI 95 %: 3.2-4.2]). Training reinforced acceptance (OR: 5.0 [CI 95 %: 4.4-5.6]) and pre-residency education provided a better understanding of ABI (OR: 2.8 [CI 95 %: 2.3-3.4]). Time needed to measure ABI was the main barrier (OR: 0.6 [CI 95 %: 0.6-0.7]). A Doppler-calculation kit (OR: 11.8 [CI 95 %: 8.9-15.6]), equipment cost≤300Euros (OR: 3.4 [CI 99 %: 3.0-3.9]), a specific fee in addition to the regular consultation fee (OR: 2.6 [CI 95 %: 2.3-3.0]) and inclusion of ABI in the GP's evaluation scheme (OR: 2.6 [CI 95 %: 2.3-2.9]) would motivate more GPs. Seven out of 10 GPs agreed that ABI has a positive impact on patient adherence to treatment and follow-up, but ABI remained underexploited for symptomatic patients (OR: 0.4 [CI 95 %: 0.3-0.4]).
  
  
  CONCLUSIONS
  Better communication and training together with an upgraded status for ABI would provide motivation for GPs to measure ABI.
authors: Service de chirurgie vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France. Electronic address: delphineg2@gmail.com.
authors: D
authors: D
authors: Meyer
authors: Service de rééducation vasculaire, hôpital Corentin-Celton, 92133 Issy-les-Moulineaux, France.
authors: J-M
authors: JM
authors: Bureau
authors: Service de rééducation et d'appareillage, institut Robert-Merle-d'Aubigné, 94460 Valenton, France.
authors: D
authors: D
authors: Vu Tri
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data; D001162:Arteriosclerosis Obliterans / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans; D005251:Fees, Medical; D005260:Female; D005602:France; D058005:General Practitioners / Q000193:education / Q000523:psychology*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
keywords: Ankle brachial index; Artériopathie des membres inférieurs; Cardiovascular diseases; General practice; HAS guidelines; Index de pression systolique; Maladies cardiovasculaires; Médecine générale; Peripheral arterial disease; Recommandations HAS