Identifying the Presence of Peripheral Artery Disease in Patients With and Without Diabetes Lori Brown, PharmD and Charles Herring, PharmD, BCPS, CPP University of North Carolina at Chapel Hill and Campbell University Schools of Pharmacy BACKGROUND OBJECTIVES METHODS LIMITATIONS and CRITIQUE 33 % n = 275 ABI tests done 81 with DM (29.5%) 73 ABI ≥ 0.9 (90.1%) 2 unknown (2.5%) 6 ABI < 0.9 (7.4%) 9 unknown (3.3%) 185 w/o DM (67.3%) 156 ABI ≥ 0.9 (84.3%) 1 unknown (0.5%) 28 ABI < 0.9 (15.1%) PATIENT SURVEY RESULTS ABI Test Results ABI Risk Assessment Data After you have had your ABI test done, please answer the following questions so that we may determine how to better serve you. n = Where was your ABI test done today (circle one)? 70.5% Pharmacy 8.7% Health fair 0.4% Doctor’s office 20.5%Other 2. Do you think this location is appropriate for this test to be conducted? 99.6% YES 0.4% NO 3. Before today, did you know that pharmacists could provide a test such as the ABI test? 88% YES 12% NO 4. How satisfied are you with the explanation and education you received from the pharmacist about your ABI test? 95.3%Very satisfied 3.1% Somewhat satisfied 1.6% Not satisfied 5. How much did you pay for your ABI test today?___________ Median $0 Mode $0 Mean $ How much would you be willing to pay for the ABI test and education that you received today?_________ Median $40 Mode $40 Mean $39 Comments:__________________________________________________ Thank you for your time Peripheral Artery Disease (PAD) is a chronic condition in which arterial vessels become narrow, reducing flow of oxygen-rich blood PAD affects 8 to 12 million Americans, but is often asymptomatic, under-recognized and often poorly treated PAD is a coronary heart disease (CHD) risk equivalent per NCEP ATP III guidelines Early identification and treatment of PAD not only slows progression but also reduces cardiovascular disease risk Ankle-Brachial Index (ABI) measurement is the gold standard for determining the presence of PAD Kerr Drug’s clinical pharmacists are trained and equipped to perform ABI in community pharmacy, MD office, and health fair settings throughout North Carolina Selection Bias - Since patients with diabetes are routinely screened for PAD, it is likely that this study’s reported prevalence of PAD in patients with diabetes is falsely low Patients previously diagnosed with IC were excluded. Since IC is a marker for PAD, we would expect to identify a higher number of PAD patients if screening procedures were expanded to include patients with a history of IC Reported data are solely descriptive Pharmacoeconomic analysis not included ABI RISK FACTOR and TEST RESULTS Primary Objective: Assess the prevalence of previously unidentified PAD in patients with and without diabetes using ABI measurements performed by community pharmacy based clinical pharmacists throughout North Carolina Secondary Objectives: Demonstrate community pharmacy PAD testing model such that other community pharmacists will be able to replicate this model in their practices easily Increase patient and physician awareness concerning risk factors and appropriate treatments for PAD and availability of PAD testing in the community pharmacy setting Expand access to and availability of PAD testing for patients in various socioeconomic groups Discuss patient satisfaction with and sustainability of PAD testing as a business model such that other community pharmacists will be able to replicate this model in their practices easily This project was funded in part by Recruit patients via expanded marketing efforts to patients, physician education, health fairs within the community, and targeted mailings to pharmacy customers and Kerr Health Care Center patients Inclusion Criteria: Patients aged 50 or older and patients of any age with one or more risk factors for PAD Exclusion Criteria: Patients with previous diagnosis of intermittent claudication (IC) or PAD, patients who have had one or more limb amputations Perform ABI tests in various community locations  Obtain informed consent  Gather risk factor information  Measure ABI  Educate patient regarding his/her ABI value and appropriate follow-up  Refer patient to physician if ABI < 0.9  Have patient complete the brief survey regarding value of test, opinion of pharmacist as test provider and testing location Calculate the prevalence of previously undiagnosed PAD for patients meeting a priori inclusion criteria for patients with and without diabetes Risk Factors Assessed  Smoking (current or former)  Age >70  Family hx DM / heart disease  Hypertension  H/O myocardial infarction  H/O stroke or TIA  High cholesterol or TG  Cholesterol-lowering Rx  Leg pain relieved upon rest  Pain in toes or feet at night  Slow healing sores or ulcers  Inactive lifestyle  ≥25 lbs overweight