Title

Improving the Early Detection and Management of Peripheral Artery Disease in Patients With Diabetes Within the Primary Care Setting

Date of Degree

12-2021

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Michael D. Moon

Abstract

Background. Diabetes is a significant risk factor for peripheral artery disease. Individuals with diabetes, greater than 50 years of age, having at least one other risk factor should be screened for peripheral artery disease with an ankle brachial index. Purpose. Improve detection and management of peripheral artery disease in persons with diabetes within primary care. Evidence. Individuals with diabetes and peripheral artery disease have an increased risk of adverse cardiac and limb events, impairing the patient’s quality of life and causing long-term disability (Berger & Newman, 2020). Methods. During a 10-week period, these processes were implemented: (a) screening all patients with diabetes for peripheral artery disease risk factors; (b) conducting ankle brachial indexes for those with risk factors; (c) assessing for statin and antiplatelet medication coverage; (d) providing diet, exercise, and smoking cessation counseling; (e) referring patients with abnormal results for vascular evaluation. Results. 257 (83%) patients were high-risk for peripheral artery disease and needed ankle brachial index screening. A total of 23 ankle brachial indexes were completed with 3 abnormal tests requiring referrals. Of the 257 evaluated, antiplatelet therapy was utilized by 172 (67%) while statin therapy was utilized by 223 (86.7%). Education was provided to 110 of the patients. Fourteen of those were active smokers. Barriers included staffing issues and the COVID pandemic. Implications. Results emphasize the importance of screening and evaluating all patients with diabetes for peripheral artery disease risk factors and implementing comprehensive guidelines. For sustainment, consideration must be given to same-day ankle brachial index testing.

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