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CVV Takes a Unique Approach to Improving PAD Symptoms

Registered Nurse Practitioner Kecia Simmons is upholding Coastal Vein and Vascular’s proud tradition of putting patient care first. Simmons, who recently completed her doctorate at Duke University, has developed and implemented a program designed to improve the quality of life of patients suffering from peripheral arterial disease (PAD). Her article detailing the project and its results was published in the March issue of Journal of Vascular Nursing.

PAD is an obstructive vascular disease which effects a significant percentage of the elderly population and whose symptoms include fatigue, cramping and pain. These symptoms can significantly reduce patient quality of life and thus Simmons was driven to develop additional treatment options to supplement the standard management plan of medication, therapy, and cessation of certain lifestyle habits such smoking.

The key, according to Simmons is increasing the frequency of exercise among eligible patients, i.e. those whose symptoms include pain associated with walking (known as “intermittent claudication” or IC). Structured exercise rehabilitation programs have been shown to significantly improve IC and have been endorsed by the College of Cardiology and the American Heart Association. Structured rehabilitation programs take place at hospitals or other facilities outside the patient’s home. Thus, difficulties arise when patients who could benefit the most from programs cannot attend due to financial or scheduling constraints. Instructing the patients to develop their own exercise regime at home, however, has not been shown to be effective.

Simmons, enlisting the help of CVV’s surgeons and other staff, developed a novel approach to buck the trend and encourage more exercise among her patients: prescriptions. The prescription form, signed and acknowledged by the patient, indicates one of three choices that the patient is to follow without supervision: walking, bicycling, or a patient specific choice of physical activity. The prescription indicates the activity is to be completed for 30 minutes (or up to patient’s maximum capacity) at least 3-5 days a week. Questionnaires administered before the protocol, and at one month follow up showed significant results. As a group, patients who enrolled in the program (which also included the receipt of a pamphlet on PAD and the importance of exercise as well as an exercise journal) reported a 35% increase in exercise as well as improvement in their symptoms.

While exercise is not a new concept to patients or their doctors, most recommendations for increased physical activity typically come in the form of suggestions or admonishments from the physician or nurse. This results in patients simply ignoring or possibly forgetting the recommendation completely. Use of a paper prescription, similar to a prescription for a medication (which patients have always appreciated as a crucial component to their care) seems to increase the likelihood that this medical advice will be followed. Perhaps it also empowers patients to take control of their care in a way they previously felt unable or unwilling to do. In essence, a prescription signed by both patient and health care provider represents an agreement to tackle the problems of PAD together.

As Simmons continues to provide excellent medical care at Coastal Vein & Vascular it can be expected that she will continue to focus her education and skills into expanding her program as well as developing new state-of-the-art protocols for improving the lives of her patients.