To tackle the present shortcomings and optimize the cohesion and collaboration between all stakeholders (including the patient and insurance companies), the ClaudicatioNet concept was launched in the Netherlands in 2011. The goal of ClaudicatioNet is to improve the quality and transparency of PAOD treatment. Including an optimal working referral system by stimulating multidisciplinary healthcare supported with innovative eHealth solutions. The ClaudicatioNet concept aims at a

nationwide enrolment. Regional networks, based on the 12 Dutch provinces and local hospital coverage are created.

 

 

Figure 1: Schematic overview of role models within the ClaudicatioNet (CNet) Concept.
PT: Physical Therapist; CHP: Coordinating Healthcare Professional; AUX TREAT: auxiliary treatment professional; SET: Supervised Exercise Treatment; CVRM: Cardiovascular Risk Management; T.: treatment; SCP: Social Community Platform.

 

 

 The role of a GP or vascular surgeon in the ClaudicatioNet concept

Setting up a regional network is initiated by vascular surgeons introducing the concept to apprehensive healthcare professionals together with local, enthusiastic and motivated PTs. Subsequently all healthcare professionals need to be familiarized with the concept and their respective roles. The first step in the patient's pathway is determining the diagnosis of IC by a physician (GP or vascular surgeon). Subsequently, a

 GP or a vascular surgeon initiates a treatment strategy (conservative vs. invasive) and supports the coordinating healthcare professional (CHP) in complex cases.

 

 

 The role of a coordinating healthcare professional in the ClaudicatioNet concept

A CHP (e.g. GP's and vascular surgeons or their supporting staff), is pivotal within the ClaudicatioNet concept and the management of the multidisciplinary treatment of PAOD patients. As can be seen in Fig. 1 the collaboration between CHP, PT
Figure 1: Schematic overview of role models within the ClaudicatioNet (CNet) Concept.
PT: Physical Therapist; CHP: Coordinating Healthcare Professional; AUX TREAT: auxiliary treatment professional; SET: Supervised Exercise Treatment; CVRM: Cardiovascular Risk Management; T.: treatment; SCP: Social Community Platform.
PATIENT AT prof AUX TREAT PHYSICIAN PT CHP SET + CVRM + Feedback Medical history CVRM + Feedback Medical history DATABASE Treatmemt outcome Benchmarking / Treatment outcome Diagnosis & T. strategy Medical history Feedback Diagnosis & T. strategy PORTAL / WEBPAGE Data connecon CNet E-Health (electronic) Paent Record CNet M-Health Non-electronic communicaon
and patient is essential in the ClaudicatioNet model. The supporting staff member of a physician (vascular nurse, GP practice assistant) accepts/takes the role of CHP. The CHP functions as a care manager coordinating a patient's CVRM and SET and comprehends the availability of high quality care in the vicinity of the patient. Furthermore the CHP collaborates closely with the PT's in the regional network overseeing the quality of care provided. Ultimately these CHP need to embrace, participate and manage their regional network based on treatment results and opinions of treated patients. Auxiliary treatment by specialized healthcare professionals (CVRM prevention and/or diabetic treatment teams) could support the CPH by providing specialized care for the patient.

 

 The role of a specialized PT in the ClaudicatioNet Concept.

 PTs need to understand the 3 year specialisation program. At the forefront of the treatment program are specialized PT´s providing SET and, if applicable, stimulate lifestyle changes and medication adherence. PTs are required to treat patients with contemporary SET programs. To guarantee this quality, ClaudicatioNet provides a professional development program for specialisation in the field of PAOD.

 

 The role of the patient in the ClaudicatioNet concept

 The patient fulfils an important role in the concept, by delivering objective as well as subjective feedback of provided care to all stakeholders (figure 1). SET outcomes like maximal walking distance, functional walking distance, quality of life and information on smoking cessation and medication compliance are useful in evaluating quality of provided care.

 

 Creating an efficient referring system

A three months SET program that actually starts 2 weeks before a three months evaluation appointment precludes evaluation of a first line conservative treatment approach and is therefore not efficient. Delay in the initiation of a SET program occurs frequently, both due to patient as well as or PT factors (holiday's, waiting lists, postponing the first appointment by the patient etc.).This will be prevented by a web-based referring system (automated patient - PT allocation and software that locates and notifies the PT closest to the patient's home). The PT should contact the patient within a limited time frame (for example 2 working days) and initiate the SET program within 5 working days. In case a PT does not make contact with the patient within two working days, a nearby PT is notified automatically. The first responder is then awarded by the possibility to treat a patient and subsequent reimbursement.