title: Vascular quality of care pilot study: how admission to a vascular surgery service affects evidence-based pharmacologic risk factor modification in patients with lower extremity peripheral arterial disease.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) guidelines recommend aggressive risk factor modification to improve cardiovascular outcomes. Recommended pharmacologic therapies include antiplatelets, angiotensin converting enzyme (ACE) inhibitors, and HMG-CoA-reductase inhibitors (statins).
  
  
  OBJECTIVE
  We studied the degree to which patient admission to a vascular surgery service increased the use of these therapies.
  
  
  METHODS
  The authors conducted a retrospective chart review of 150 patients with PAD admitted to the vascular surgery service at a large Canadian tertiary care hospital. The use of recommended pharmacologic therapies at the time of admission and discharge were compared. A multidisciplinary clinical team established criteria by which patients were deemed ineligible to receive any of the recommended therapies. Angiotensin receptor blockers (ARBs) were considered an alternative to ACE inhibitors.
  
  
  RESULTS
  Prior to hospital admission, 64% of patients were on antiplatelet therapy, 67% were on an ACE inhibitor or ARB, and 71% were on a statin. At the time of discharge, 91% of patients were on an antiplatelet (or not, with an acceptable reason), 77% were on an ACE inhibitor or an ARB (or not, with an acceptable reason), and 85% were on a statin (or not, with an acceptable reason). While new prescriptions were largely responsible for improved guideline adherence with antiplatelets and statins, most of the apparent improvement in ACE inhibitor and ARB use was the result of identifying an acceptable reason for not having them prescribed.
  
  
  CONCLUSIONS
  This hypothesis generating pilot study supports the findings of others that there is suboptimal prescription of pharmacologic risk reduction therapies in the PAD population. Admission to a vascular service increases these rates. Nevertheless, some patients are still not receiving evidence-based treatment at discharge even after consideration of acceptable reasons. Strategies are needed to improve PAD guideline adherence in both the community at large and the vascular surgery service.
authors.affiliation: Department of Pharmacy, University Health Network, Toronto, ON, Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Naomi
authors.initials: N
authors.lastname: Steenhof
authors.affiliation: Department of Pharmacy, University Health Network, Toronto, ON, Canada.
authors.forename: Francesca
authors.initials: F
authors.lastname: Le Piane
authors.affiliation: Department of Pharmacy, University Health Network, Toronto, ON, Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada ; Centre for Innovation in Complex Care, University Health Network, Toronto, ON, Canada.
authors.forename: Kori
authors.initials: K
authors.lastname: Leblanc
authors.affiliation: Division of Vascular Surgery, University Health Network, Toronto, ON, Canada.
authors.forename: Naomi R
authors.initials: NR
authors.lastname: Eisenberg
authors.affiliation: Department of Pharmacy, University Health Network, Toronto, ON, Canada.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kwan
authors.affiliation: Department of Pharmacy, University Health Network, Toronto, ON, Canada ; Victoria General Hospital, Vancouver Island Health Authority, Victoria, BC, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Malmberg
authors.affiliation: Faculty of Nursing, University of Toronto, Toronto, ON, Canada ; Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papadopoulos
authors.affiliation: Division of Vascular Surgery, University Health Network, Toronto, ON, Canada ; Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada ; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Graham
authors.initials: G
authors.lastname: Roche-Nagle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010343:Patient Admission; D010351:Patient Discharge; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D002317:Cardiovascular Agents
keywords: guideline adherence; risk reduction; vascular protection