Increased health care utilization by patients with peripheral arterial disease in primary care: data from the CONTENT study

Abstract

Background: Due to demography the proportion of elderly patients with peripheral arterial disease (PAD) in primary care settings is continuously growing. The study aimed to compare general practitioner care of patients with PAD with those without PAD. Patients and methods: The analyzed data are derived from the general practice morbidity research network CONTENT (CONTinuous morbidity registration Epidemiologic NETwork). A sample of 480 patients with ensured PAD diagnosis was extracted from a total of 89516 steadily registered primary care patients. Matched pair analysis with the propensity score was used statistically to compare the data of each PAD patient with data of three associated control patients. Results: During a two-year period, PAD patients had significantly more consultations (20.1 vs. 18.0; p < 0.0001), more referrals to specialists (5.5 vs. 3.5; p < 0.0001) and a higher rate of hospitalization (0.3 vs. 0.1; p < 0.0001) than corresponding controls. The analysis of reasons for doctor-patient encounters showed a significantly higher number of disordered sleep, alcohol abuse, dyspnea and tobacco abuse among PAD patients compared to patients without PAD. The ranking of the most frequent reasons for referral to specialists suggested significantly more diagnoses related to cardiovascular disease in PAD patients. In the PAD cases, 20.4 % of all inpatient treatments were related to complications of the vascular disease, whereas no patient of the control group had to be hospitalized due to vascular disease problems. Conclusions: The CONTENT episode-based registration presents a realistic and detailed picture of health care utilization of PAD patients. They overuse medical services in primary care compared to corresponding unaffected patients. This is associated with deficits in their life-style behavior, increased cardiovascular morbidity and increased inpatient care.