PRIMARY CARE PHYSICIANS DIAGNOSIS AND MANAGEMENT OF VASCULAR PATHOLOGIES
Noash Marie Julia Rios, Jorge Martinez Trabal, Rafael Santini-Dominguez.
Hospital Episcopal San Lucas, Ponce, PR, USA.
OBJECTIVES: There's a shortage of vascular surgeons in the United States with a predicted worsening in the upcoming years. Recent data suggest 1.4 vascular specialist are needed for every 100,000-population showing a shortage of more than 25 surgeons in Puerto Rico. The increasing incidence and prevalence of vascular pathologies and the lack of vascular specialists increases the importance of primary care physicians (PCPs) diagnosing and managing these pathologies. Here we intend to assess how confident and prepared PCPs feel about diagnosing and managing vascular diseases.
METHODS: An 18 questions survey evaluating physicians’ demographics, preparedness and confidence diagnosing and managing vascular pathologies was distributed by the Medical College of Puerto Rico. A 1-5 Likert scale for quality and confidence was used. A score of 3 or less was considered inadequate. As well factors affecting transfers and referral to vascular specialists were assessed. RESULTS: Title of table: Primary Care Physicians Demographics
|Location||Type of Practice||Experience|
|North||47%||Private Office||36%||< 10 years||30%|
|South||25%||Private hospital||33%||10-20 years||28%|
|West||15%||Teaching hospital||16%||20-30 years||20%|
161 PCPs answered the survey, 49.69% were females (Table 1). 67% responded medical school training in vascular pathologies was fair quality or worse. While advancing in their career 44% stated having fair or worse training during residency and 41% during fellowship. Also, 43% of them answered fair or worse continuing medical education. While gathering the responses on the confidence in treatment and management 67% responded feeling “somewhat confident” or less treating aortic diseases, 46% treating peripheral arterial diseases, 47% treating venous diseases, and 64% treating carotid disease. 90% of them would like to know more about the diagnosis and management of vascular pathologies. When comparing general practitioners to internal medicine specialists, the former feel less confident treating vascular pathologies. According to the responses the number one factor affecting transfer or referral to a vascular specialist in Puerto Rico is the inability of contacting one
CONCLUSIONS: With the increasing prevalence and incidence of vascular pathologies and shortage of vascular specialist it is up most important to reconsider medical school and residency training in the diagnosis and management of these pathologies. Many primary care physicians feel the quality of their training and confidence in diagnosis and management of vascular pathologies is not adequate.
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