[Ankle brachial index: motivations, training, and practices among 165 general practitioners in Île-de-France]. / Index de pression systolique et médecine de ville : motivation, formation, mesure et valorisation de l'acte. Enquête auprès d'un échantillon de 165 médecins généralistes d'Île-de-France.

ABSTRACT

UNLABELLED Peripheral arterial disease (PAD) is under-diagnosed despite its predictive value for cardiovascular mortality. The ankle brachial index (ABI), a simple reliable measure recommended by the French health authorities to detect and evaluate the severity of PAD, is used by too few general practitioners (GPs). OBJECTIVE: This study aimed at identifying motivations and barriers for using ABI in general practice. METHOD: A representative, descriptive, cross-sectional survey was conducted amongst 165 GPs practicing in Île-de-France who were interviewed using stratified quotas. RESULTS: Although 1 out of 5 GPs considered ABI to be an irrelevant indicator, most had a favorable opinion about its use (OR 4.9 [CI 95 % 4.2-5.7]). Only 42 % (CI 95 % 34 %-49 %) of GPs knew ABI was recommended by the health authorities. This information had a critical impact on the acceptance of ABI relevancy (OR 3.7 [CI 95 % 3.2-4.2]). Training reinforced acceptance (OR 5.0 [CI 95 % 4.4-5.6]) and pre-residency education provided a better understanding of ABI (OR 2.8 [CI 95 % 2.3-3.4]). Time needed to measure ABI was the main barrier (OR 0.6 [CI 95 % 0.6-0.7]). A Doppler-calculation kit (OR 11.8 [CI 95 % 8.9-15.6]), equipment cost≤300Euros (OR 3.4 [CI 99 % 3.0-3.9]), a specific fee in addition to the regular consultation fee (OR 2.6 [CI 95 % 2.3-3.0]) and inclusion of ABI in the GP's evaluation scheme (OR 2.6 [CI 95 % 2.3-2.9]) would motivate more GPs. Seven out of 10 GPs agreed that ABI has a positive impact on patient adherence to treatment and follow-up, but ABI remained underexploited for symptomatic patients (OR 0.4 [CI 95 % 0.3-0.4]). CONCLUSION: Better communication and training together with an upgraded status for ABI would provide motivation for GPs to measure ABI.