Objective

Patients with intermittent claudication (IC) are initially treated with supervised exercise therapy (SET), as advised by national and international guidelines. Dutch health insurance companies and the Dutch National Health Care Institute suggested an 87% compliance rate with these guidelines in the Netherlands in 2017 and judged this to be undesirably low. The aim of this study was to evaluate compliance with IC guidelines and to elaborate on the reasons for deviating from them (practice variation) in a large teaching hospital.

Methods

A retrospective single centre cohort study was conducted at a large teaching hospital in the Netherlands. In total, 420 patients with newly diagnosed IC between 1 January 2017 and 31 December 2018 were analysed. Data included risk profiles and prescribed therapies.

Results

For all 420 included patients, the compliance rate with the guidelines for SET was 80.5%. The rate of adequately motivated and defensible practice variation was 15.7%; the rate of unjustified practice variation was 3.8%. Meaningful care was seen in 96.2% of cases.

Conclusion

Deviation from IC guidelines was found in 19.5% of patients. Almost three quarters of this deviation can be explained by the decision to provide personalised, meaningful care.

中文翻译：

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间歇性跛行患者与全国指南的实际实践偏差

客观的

根据国家和国际指南的建议，间歇性跛行 (IC) 患者最初接受有监督的运动疗法 (SET) 治疗。荷兰健康保险公司和荷兰国家卫生保健研究所建议 2017 年荷兰对这些准则的遵守率为 87%，并认为这是不合需要的低。本研究的目的是评估对 IC 指南的遵守情况，并详细说明在一家大型教学医院中偏离这些指南的原因（实践差异）。

方法

在荷兰的一家大型教学医院进行了一项回顾性单中心队列研究。总共分析了 2017 年 1 月 1 日至 2018 年 12 月 31 日期间新诊断为 IC 的 420 名患者。数据包括风险概况和处方治疗。

结果

对于所有纳入的 420 名患者，对 SET 指南的依从率为 80.5%。充分动机和可辩护的实践变异率为 15.7%；不合理的实践变异率为 3.8%。在 96.2% 的病例中看到了有意义的护理。

结论

在 19.5% 的患者中发现偏离 IC 指南。这种偏差的近四分之三可以通过提供个性化、有意义的护理的决定来解释。