English summary: FURTHER DEVELOPMENT AND VALIDATION OF CRITERIA FOR REFERRAL OF PATIENTS WITH CLAUDICATION

Background

It is estimated that there are approximately 100 000 patients suffering from claudication in Finland.

Because of limited resources in the health care system it is impossible to offer everyone invasive treatment. Teams of experts appointed by the Ministry of Social Affairs and Health have drawn up national guidelines on treating illnesses in the form of questionnaires. The aim of this study was to explore how the questionnaires allocate claudication patients to invasive treatment compared with former practice.

Methods

The questionnaires were tested retrospectively on 101 claudication patients waiting for lower extremity angiography in the Department of Vascular Surgery of Helsinki University Hospital Meilahti in winter and spring 2004.

Results

50 points out of 100 was taken as the minimum score for access to invasive treatment. With the first questionnaire 86 (92%), with the second, simpler questionnaire 53 (56%) and with the third, modified questionnaire 89 patients (95% of all the patients on the list) scored at least 50 points. The third questionnaire was taken as the basis for the final national guideline for treating claudication patients.

Conclusions

Some of the patients in need of invasive treatment may be left without it with the new national guidelines if the practice before the study is taken as the gold standard of treatment of claudication. Different types of questionnaires had to be tested to find a compromise satisfying both the Ministry's interests and the usual practice in vascular surgery.