The ClaudicatioNet concept: design of a national integrated care network providing active and healthy aging for patients with intermittent claudication

Abstract

Introduction: Intermittent claudication (IC) is a manifestation of peripheral arterial occlusive disease (PAOD). Besides cardiovascular risk management, supervised exercise therapy (SET) should be offered to all patients with IC. Outdated guidelines, an insufficient number of specialized physiotherapists (PTs), lack of awareness of the importance of SET by referring physicians, and misguided financial incentives all seriously impede the availability of a structured SET program in The Netherlands.

Description of care practice: By initiating regional care networks, ClaudicatioNet aims to improve the quality of care for patients with IC. Based on the chronic care model as a conceptual framework, these networks should enhance the access, continuity, and (cost) efficiency of the health care system. With the aid of a national database, health care professionals will be able to benchmark patient results while ClaudicatioNet will be able to monitor quality of care by way of functional and patient reported outcome measures.

Discussion: The success of ClaudicatioNet is dependent on several factors. Vascular surgeons, general practitioners and coordinating central caregivers will need to team up and work in close collaboration with specialized PTs. A substantial task in the upcoming years will be to monitor the quality, volume, and distribution of ClaudicatioNet PTs. Finally, misguided financial incentives within the Dutch health care system need to be tackled.

Conclusion: With ClaudicatioNet, integrated care pathways are likely to improve in the upcoming years. This should result in the achievement of optimal quality of care for all patients with IC.

Keywords: active healthy aging; chronic care model; integrated care network; intermittent claudication; supervised exercise therapy.

Figure 1

The chronic care model. Adapted by permission from BMJ Publishing Group Limited. Improving the quality of health care for chronic conditions, Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH, 13, 299–305, © 2004.

Figure 2

Integrated care pathways. Abbreviations: CVRM, cardiovascular risk management; GP, general practitioner; PAOD, peripheral arterial occlusive disease; PT, physiotherapist.