DEFINING THE CARE GAP IN AAA SCREENING: PRACTICAL APPROACHES TO IMPROVED GUIDELINE IMPLEMENTATION

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Douglas L. Wooster, MD, Andrew Dueck, MD, Elizabeth Wooster, BComm.
University of Toronto, Toronto, ON, Canada.

OBJECTIVES: Despite well-publicized guidelines for AAA screening, there has been limited implementation of these by primary care physicians. The aims of this study were to identify barriers specific to ultrasound (U/S) AAA screening, identify the interactions within the clinical care team and propose implementation strategies.
METHODS: Stakeholder groups of primary care physicians (PCP), imaging specialists (IS) and vascular specialists (VS) were identified. Structured surveys and semi-structured focus groups were used with each.
RESULTS: All groups believed in screening in general, that AAA was an important disease and U/S was the best test (78 - 90%). Awareness of guidelines varied: IS 12%, PCP 42%, VS 78%. 61% of PCP saw >12 eligible pts/week but 77% screened <20%. VS screen <60% if carotid disease or PAD (84 - 86%) and <20% if VV (76%). Patient characteristics, costs and availability of resources were not seen as barriers. PCP & IS were uncertain of the evidence, cost-effectiveness and whether patients had had a previous U/S. VS had ethical concerns and noted that PCP should initiate screening. VS would advocate for screening (67%) but IS were reluctant to (20 - 30%). All agreed that guideline implementation should be patient-centered, expert/opinion leader reinforced and supported by reminders. There was limited interest in government initiatives, EMR or internet training modules.
CONCLUSION: A care gap was identified related to knowledge and practice gaps. Multifaceted implementation strategies with coherent team interactions and advocacy are required to enhance guideline uptake and optimize patient care.

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