Barriers impede use of EBMT in patients with PAD

Multiple factors contribute to the low uptake of evidence-based medical therapy (EBMT) in the management of peripheral artery disease (PAD), reports a Singapore study.

Some of these barriers include the lack of guideline awareness among healthcare professionals (HCPs), frequent referrals, limited generalizability of the guidelines to all patients, patient’s complicated conditions, patients’ limited understanding of their medications, cost, and short consultation time.

“Findings from this study may inform strategies for improving healthcare professionals’ adherence to guidelines and patients’ medication adherence,” the researchers said.

This qualitative study was carried out in a tertiary hospital in Singapore from December 2021 to March 2023 and included HCPs and in-patient pharmacists, as well as patients with PAD who had undergone a lower limb angioplasty revascularization procedure.

Semi-structured interviews were conducted to obtain data. These interviews were audio-recorded, transcribed, and systematically coded using the NVivo 12.0 software. Finally, the researchers used the Tailored Implementation for Chronic Diseases framework to guide the interviews and analysis.

Four PAD patients and 12 HCPs, including four junior consultants, seven senior consultants, and one senior in-patient pharmacist, participated in this study. Nine themes in seven domains were identified. [Ann J Acad Med Singap 2023;52:651-659]

Analysis revealed that only a few doctors were aware of the relevant guidelines, and their main concern was the generalizability of said guidelines to patients with complicated conditions. Other factors related to the underutilization of EBMT were cost, frequent referrals, lack of collaboration among HCPs, not being the patients’ long-term care providers, short consultation time, and limited knowledge.

Lack of awareness

“At the HCP level, a surprising finding was that most doctors were either not aware of any PAD guidelines or never searched for relevant guidelines,” the researchers said.

This finding was consistent with those of previous studies that reported inadequate awareness of clinical practice guidelines among HCPs in other disease areas. [Am J Cardiol 2008;102:1142-1145; Int J Nurs Stud 2020;103:103503]

“At the patient level, the most significant barrier to adhering to EBMT was inadequate knowledge of their medications,” the researchers said.

A recent study stressed the substantial role played by medication knowledge in improving adherence among patients with chronic diseases. [Int J Clin Pharm 2023;45:38-51]

“Limited health literacy is a possible explanation for why many patients were not on antiplatelet therapy even though they had gone through several surgical interventions,” the researchers said. “To tackle this problem, the doctors highlighted an urgent need to involve HCPs to educate them on the importance of taking medications.”

Finally, at the system level, interprofessional collaboration was lacking and therefore required further improvement. One doctor said that this factor resulted in the inadequate use of EBMT.

“This highlights the need to improve interprofessional communication by engaging a care manager to share regular updates of a patient and develop a comprehensive coordinated care plan,” according to the researchers.

“Future interventions are needed to enhance EBMT utilization in PAD management,” they said.