Supervised exercise therapy: better and safer care for less money!
ClaudicatioNet is an excellent example of a significant increase in patient value. By realising and implementing a stepped care model in the Netherlands, which is unique in the world, over 30 million euros can be saved per annum.
Treatment options for intermittent claudication (IC) are described in evidence-based international guidelines. The approach should be aimed at cardiovascular risk reduction encouraging lifestyle changes and prescribing medication. This should be combined with treatment of IC symptoms, preferably by referring patients for supervised exercise therapy (SET), otherwise by endovascular or surgical revascularization.
However, in daily practice many patients receive an invasive intervention by means of an angioplasty (‘dotter’) or bypass surgery, instead of a SET program first approach. Such a “stepped care” model (SCM) strives to initially refer all IC patients to SET, whereas revascularization is restricted to patients not sufficiently responding to SET. This is also the strategy recently endorsed by the NICE guidelines. NICE favours exercise therapy because of low risks and costs. In this way patients are not burdened by an invasive treatment and its associated risks and costs. Risks and costs that may appear not to be necessary after 3 months of SET.
In the last 3 years, ClaudicatioNet has set up a nationwide network of 1400 qualified and specifically trained physiotherapists (PT’s) to provide SET for patients with PAD and provide life style counselling (smoking cessation, dietary advise) with the use of motivational interviewing techniques.
For a complete overview of ClaudicatioNet, please refer to www.claudicationet.nl.