A rapid review of pathways to diagnosis for people living with peripheral artery disease.

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Zoe Clothier, Jo Armes, Christian Heiss, Jenny Harris
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引用次数: 0

Abstract

Background: Peripheral artery disease (PAD) remains under-recognised. Low awareness among the public, patients and healthcare professionals (HCPs) contributes to delayed diagnosis and poorer outcomes. This rapid review applied the Model of Pathways to Treatment (MPT) to synthesise behavioural and system-level factors shaping the diagnostic pathway and identifies evidence gaps to inform intervention and service redesign. Patients and methods: Databases (CINAHL, PubMed, PsycINFO) were searched (January 2001-July 2024) for qualitative, quantitative or mixed-methods studies exploring PAD diagnosis from the perspective of patients, at-risk public or HCPs. Eligible studies examined events, behaviours or timings linked to PAD diagnosis. Quality was assessed using the Mixed Methods Appraisal Tool and findings synthesised using the MPT. Results: Twenty-one studies (13 quantitative, 7 qualitative, 1 mixed method) were included. Mapping to the MPT revealed modifiable, multifactorial barriers across the diagnostic pathway from symptom appraisal to pre-treatment. At the patient level, symptom misattribution, normalisation, competing priorities, fear and financial concerns delayed help-seeking. At the provider level, HCPs often lacked training, confidence or incentives to assess PAD, with underuse of tools including the ankle-brachial index. At the system level, referral delays were linked to unclear pathways and limited feedback from vascular services. Only one study explored variations in diagnosis timeline by population or setting. Conclusions: Although PAD is under diagnosed and associated with poor outcomes, few studies have examined the behavioural and structural factors delaying diagnosis. This review identifies missed opportunities along the diagnostic pathway and highlights targets for future research and intervention across patient, HCP and system levels.

外周动脉疾病患者诊断途径的快速回顾
背景:外周动脉疾病(PAD)仍未得到充分认识。公众、患者和医疗保健专业人员(HCPs)的低意识导致诊断延迟和预后较差。这项快速审查应用了治疗途径模型(MPT)来综合影响诊断途径的行为和系统级因素,并确定证据差距,为干预和服务重新设计提供信息。患者和方法:检索数据库(CINAHL, PubMed, PsycINFO)(2001年1月- 2024年7月),从患者,高危公众或HCPs的角度探讨PAD诊断的定性,定量或混合方法研究。符合条件的研究检查了与PAD诊断相关的事件、行为或时间。使用混合方法评估工具评估质量,并使用MPT综合结果。结果:共纳入21项研究,其中定量法13项,定性法7项,混合法1项。对MPT的映射揭示了从症状评估到治疗前的诊断途径中可修改的多因素障碍。在患者层面,症状错误归因、正常化、优先事项竞争、恐惧和经济担忧延迟了求医。在医护人员层面,HCPs往往缺乏培训、信心或动机来评估PAD,包括踝肱指数在内的工具使用不足。在系统层面,转诊延迟与不明确的路径和有限的血管服务反馈有关。只有一项研究探讨了人群或环境对诊断时间的影响。结论:尽管PAD未得到诊断且预后较差,但很少有研究检查延迟诊断的行为和结构因素。本综述确定了沿着诊断途径错过的机会,并强调了未来在患者、HCP和系统层面进行研究和干预的目标。
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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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