Summary

Peripheral arterial disease (PAD), a.k.a peripheral vascular disease (PVD), is a condition where fatty deposits build up inside blood vessels and reduce the flow of blood to the legs.

Care pathways

This pathway is designed to assess how well patients with PAD are managing their overall CVD risk, and prevent development of secondary conditions (stroke, heart attack, kidney failure, loss of limb).

1️⃣ Book the appointment

1. We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
• If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
• If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists

2. Call the patient to book an appointment with an HCA
3. Explain to the patient what the appointment is for, and advise them that they will have a blood test on the day and that they must produce a fresh urine sample on the day of their appointment
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About urine samples

2️⃣ Patient arrives for appointment

1. Record that the patient has arrived in the appointment book
2. Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
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How-to guides

3️⃣ Carry out review

1. Open the clinical template: ‘Penrose Health - Peripheral Arterial Disease (PAD)’ on EMIS
2. Draw bloods (for liver function, HbA1c, cholesterol, eGFR) and collect a urine sample (for ACR)
3. Perform a foot check
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How-to guide
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All patients should have a foot check (not just those who are diabetic)
4. Complete pg. 1-4 of the template
5. Make appropriate referrals as below
• For BMI, refer to 🍎The Lambeth Healthy Weight Hub, 🍎Up! Up! Lewisham (Tier 2 Weight Management), 🍎NHS Tier 2 Weight Management Service or 🍎NHS Tier 3 Healthy Weight Programme as appropriate
• For smoking cessation, refer to 🚭Southwark Stop Smoking Service, 🚭Lewisham Stop Smoking Service or 🚭Lambeth Stop Smoking Service
1. For moderate/high risk foot check, follow ‘Diabetes Foot Care Pathway’ on DXS, and refer to 🦶Community Foot Health (Podiatry) or 🦶Multi-disciplinary Foot (MDFT) Clinics
6. Provide advice on reducing alcohol intake, as appropriate

4️⃣ Check & triage results

1. Review pathology results, and action as per the 🔬Lab Reports (Path Links) page. If, according to this page, a follow-up appointment is required, progress to step five below.

5️⃣ Follow-up appointment

1. Open the clinical template: ‘Penrose Health - Peripheral Arterial Disease (PAD)’on EMIS

2. Check that the patient is on a statin or other lipid-lowering therapy
• If not, initiate medication
• If they are but QRISK2 is out of range, review dosage

3. Discuss the treatment plan with the patient, using the ‘Management’ page of the template & NICE management guidelines
4. Make appropriate referrals
5. As blood pressure measurements are off-target according to the Hypertension Guidance for Primary Care in South East London, a follow-up will be needed as this could be an indicator of 📈Hypertension
6. As HbA1c is off-target, a follow-up is needed as this could be an indicator of 🍏Pre-diabetes or 🍎Diabetes