Heterogeneity in venous disease practice patterns amongst primary healthcare practitioners

Vascular. 2015 Aug;23(4):391-5. doi: 10.1177/1708538114552011. Epub 2014 Sep 22.


Introduction: This study aimed to describe the practice patterns of primary healthcare practitioners who diagnose and manage venous disease to determine differences in clinical evaluation of disease, recognition of venous ulcers, and referral patterns.

Methods: A survey was distributed at the August 2011 Primary Care Medical Conference (Pri-Med) in Baltimore, Maryland. Pri-med is a medical education company that caters to the continued professional development needs of a variety of physicians.

Results: A total of 305 surveys were completed. Of the respondents, 91% were physicians and 9% were advanced level practitioners. In all, 93% prescribed compression stockings as first-line treatment. Heterogeneous referral patterns were reported with 81% referring to vascular surgery, 25% to a vein clinic, 10% to interventional radiology, and 3% to interventional cardiology. Up to 35% responded that they met resistance (did not have their referral accepted) when attempting referral to a vascular surgery colleague. There was substantial variation when asked about the treatment of deep vein thrombosis with 88% starting anticoagulation therapy, 54% prescribing compression stockings, 40% doing a thrombophilia workup, and 25% referring for lytic therapy.

Conclusion: Diagnosis and management aptitude of venous disease is highly variable. Further grassroots education is required to improve diagnosis and treatment in patients with chronic venous disease.

Keywords: Venous disease; management of venous disease; superficial thrombophlebitis; thrombophlebitis care.

MeSH terms

  • Anticoagulants / therapeutic use
  • Baltimore
  • Education, Medical, Graduate / trends
  • Female
  • Health Care Surveys
  • Humans
  • Inservice Training / trends
  • Male
  • Middle Aged
  • Physicians, Primary Care / education
  • Physicians, Primary Care / trends*
  • Practice Patterns, Physicians' / trends*
  • Primary Health Care / trends*
  • Prognosis
  • Radiography, Interventional / trends
  • Referral and Consultation / trends
  • Stockings, Compression / trends
  • Surveys and Questionnaires
  • Thrombolytic Therapy / trends
  • Varicose Ulcer / diagnosis
  • Varicose Ulcer / therapy*
  • Vascular Surgical Procedures / education
  • Vascular Surgical Procedures / trends
  • Venous Insufficiency / diagnosis
  • Venous Insufficiency / therapy*
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / therapy*


  • Anticoagulants