Managing Peripheral Arterial Disease With a Multidisciplinary Team

Q: Why is multidisciplinary management of peripheral arterial disease (PAD) so important?
 
Much of the literature shows that outcomes for PAD are vastly improved by the utilization of a multidisciplinary team. There have been national and international reports over the past 20 years that validate the value of a multidisciplinary team in preventing amputations and healing wounds faster.^1,2 This is important as a patient’s quality of life is not just determined by the absence or presence of a wound—quality of life is also measured by pain management, ability to work, and ability to engage in social activities with loved ones. Thus, returning a patient to their pre-ulcer baseline is very critical.
 
Q: Who are the most important healthcare providers to have on your team?
 
I feel that the medical assistants are the unsung heroes on the team. Typically, the patients have a greater level of comfort and ease around the assistants. They frequently relay information to the assistants, information that they are nervous about sharing with the physician or wound care nurse. Because the assistants spend more time face to face with the patient, they establish a deeper level of trust and understanding with the patient.
 
Q: Can you give any examples of how a multidisciplinary team helped in your practice?
 
Being able to work concurrently with vascular and orthopedics on the complex patients expedites treatment. It also allows for clear, direct communication between colleagues. When the teams don't have open, direct channels of communication, there is much room for treatment delays and misunderstanding on the goals of treatment.
 
Q: Is there any emerging research or new data when it comes to managing PAD that clinicians should be aware of?
 
Yes, I would recommend that practitioners look at the latest guidelines put forth by the International Working Group for the Diabetic Foot for 2023.³ The guidelines are intersocietal and have robust, clear recommendations.
 
Dr. Dove is the Director of Clinical Research at the Department of Orthopaedics, Division of Podiatry at UT Health Science San Antonio. Dr. Dove has served as a Principal Investigator in over 50 clinical trials over the past 20 years.  She is currently establishing a research program in which her colleagues, residents and students will be actively engaged. Dr. Dove was previously in private practice in Las Vegas. Her private practice combined industry sponsored research and general podiatry, with a focus on wound care. Before opening her practice, Dr. Dove was the director of podiatry at the Diabetic foot and Ankle Center, Hospital for Joint Disease, NYU.
 
References
 
1. McDermott KM, Srinivas T, Abularrage CJ. Multidisciplinary approach to decreasing major amputation, improving outcomes, and mitigating disparities in diabetic foot and vascular disease. Semin Vasc Surg. 2023 Mar;36(1):114-121. doi: 10.1053/j.semvascsurg.2022.11.001. Epub 2022 Nov 12. PMID: 36958892.
 
2. Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg. 2020 Apr;71(4):1433-1446.e3. doi: 10.1016/j.jvs.2019.08.244. Epub 2019 Oct 30. PMID: 31676181; PMCID: PMC7096268.
 
3. Hon K, Nobels F, Senneville É, Uckay I, Maas M, Fitridge R. Assessment and management of diabetes-related foot infection according to the new International Working Group on the Diabetic Foot guidelines 2023-Multidisciplinary grand rounds. Diabetes Metab Res Rev. 2023 Oct 19:e3737. doi: 10.1002/dmrr.3737. Epub ahead of print. PMID: 37855302.