Initiative brings awareness, resources to rural Minnesota

Nurse Amber Keyes checked a patient’s blood pressure in both the arms and the legs, one of the initial tests in diagnosing PAD. Contributed photo

If you are 65 or older and have pain or discomfort in the muscles of your legs or buttocks when you walk, that goes away when you rest, you may have a disease called peripheral artery disease or PAD.

PAD is a disease in which plaque, or fatty deposits, buildup in the arteries that supply blood flow to the legs. PAD often results in cramping, aching or fatigue in the calf, thigh or buttock muscles that comes on with walking. It is relieved by rest.

“PAD is similar to heart disease in that the plaque builds up, but the buildup takes place in the legs,” said Dr. Diane Treat-Jacobson, Ph.D., RN, FAAN, Professor in the School of Nursing at the University of Minnesota. “Some people think that leg pain is a normal part of aging but it is not. We know between eight and 12 million people in the US have PAD, and there are a lot of people who are undiagnosed.”

“People have known about PAD for a long time, however it was thought to be benign for many years. Now we know from long-term follow up studies that people with PAD have a significantly higher mortality rate compared to the general population without PAD. If left untreated, PAD can lead to debilitating pain, foot ulcers, amputation, and cardiovascular and carotid disease leading to heart attack stroke. In 2015, the University of Minnesota School of Nursing began a partnership with several rural healthcare organizations in west-central Minnesota to create the PAD PRAIRIE Initiative to increase awareness, diagnosis and treatment of PAD. A team of registered nurses from the University of Minnesota support implementation of the initiative in the healthcare facilities to provide education to the community, to healthcare providers, and nurses; facilitate free public PAD screenings; and provide effective supervised exercise therapy for individuals with PAD. The initiative is led by Treat-Jacobson, a pioneering researcher in non-invasive treatments for PAD. Team members include nurses, exercise therapists, physical therapists, administrative staff, and physicians from Lake Region Healthcare, Otter Tail County Public Health, Stevens Community Medical Center, Prairie Ridge Hospital and Health Services, Glacial Ridge Health System, and the University of Minnesota School of Nursing.

PAD screening events have been held throughout west central Minnesota to help diagnosis PAD. Using a handheld Doppler, the healthcare professional compares the blood pressure in the arms with the blood pressure in the ankles as the patient rests comfortably on a massage-like table.

“We want to get to people before they have such pain that they find it difficult to walk,” said Treat-Jacobson, “PAD is definitely harder to treat the longer it is left untreated. It gets much more complicated.”

Another important part of the initiative is education. The initiative team members meet with medical staff and other healthcare staff members at each of the healthcare sites to discuss and review diagnosis and treatment of PAD.

“PAD is often mistaken for arthritis, lower back problems, hip and knee issues or just the aches and pains of aging,” said Treat-Jacobson. “Improving assessment and diagnosis of PAD is the first and most essential step to improving care and outcomes for patients.”

The healthcare organizations also offer PAD education and several will be boosting those efforts in September during PAD Awareness Month.

Laurissa Stigen, nurse, checks a patient using an ankle brachial index (ABI) examination, one of the key tests to diagnosing peripheral artery disease (PAD). Contributed photo

Supervised exercise therapy is the third component of the PAD PRAIRIE Initiative. Patients identified with PAD receive coaching on lifestyle changes related to blood pressure, cholesterol, diabetes and smoking cessation. Patients are also invited to enroll in the PAD supervised exercise program funded by the grant. Patients are taught how to exercise effectively with PAD and leg pain.

“Using a treadmill or a NuStep machine has shown to decrease discomfort and improve walking distances,” said Treat-Jacobson, who added that “aerobic exercises can improve the blood flow and health of the blood vessels. People want to remain independent in their homes. Catching PAD early and improving the ability to walk make this possible.”

The PAD Initiative partnership includes five health care organizations, but may grow if there is interest.

“We are definitely willing to expand to new communities in west-central Minnesota,” said Treat-Jacobson. According to project coordinator, Rebecca Brown, the partnerships have been a success because there is great learning happening on both sides.

“We have excellent champions in each healthcare organization who know their patients, their communities and their systems,” said Brown. “And we are learning to be flexible, listen well, and be physically present in each community as much as possible.”

Since the beginning of the PAD PRAIRIE Initiative, the team set out to make supervised exercise therapy available to rural Minnesotans suffering from PAD. In 2017, Centers for Medicare and Medicaid announced their decision to expand national coverage determination to include supervised exercise therapy for beneficiaries with symptomatic PAD, a victory Dr. Treat-Jacobson and national vascular nursing, medicine, and surgery colleagues have been waiting 20 years to see. Thanks to the efforts of Dr. Treat-Jacobson, rural healthcare partners, and national PAD advocates, supervised exercise therapy for PAD will continue to expand.

To learn more about PAD and/or to ask about a PAD screening, contact your healthcare provider or visit the PAD PRAIRIE Initiative website at z.umn.edu/padprairie, call or email the PAD PRAIRIE Initiative team at 844-236-6211 or padumn@umn.edu.

The three-year PAD Prairie Initiative launched in 2015 is funded by a $1.6 million grant from the Margaret A. Cargill Foundation.