Observatory for screening and management of vein disease in general medicine

The Vein Consult program is the first worldwide venous diseases observatory; its french results are presented here. Thirty three thousand and ninety seven patients, mean age 51 year, and females for 70% of them, were included in the study. Nearly two-thirds (65.5%) of the patient base of general practitioners, had presented during seven years on average symptoms of venous disorders, dominated by heavy legs (48.9%), pain (40.9%) and bloating (37.4%). Forty eight per cent of patients who did not consult for this reason were however directly concerned by signs and/or symptoms of venous disorders. These results demonstrate that the disease is underestimated by physicians and patients themselves, despite the presence of typical clinical features signing their entry into the venous disease. In recent years, three important modifications, related to the publication of the latest international consensus on the management of vein disease, have occurred in the management of patients presenting with venous insufficiency: - the appearance of a care pathway and the role of the general practitioner (GP); - the discontinued reimbursement of phlebotropic drugs; - continued reimbursement of compression. The creation of a care pathway and the pivotal role of the general practitioner have led to a reduction in direct access to specialist consultations, which are now only reimbursed at 35%, if they were not prescribed by their GP. In addition, the discontinued reimbursement of phlebotropic drugs has not only disturbed patients, but has also left them to manage their disease themselves, which may give rise to hesitations. Today, treatment with phlebotropic drugs must comply with the consensus conference on the management of chronic vein disease [1]. In particular, the conference carried out an exhaustive review of the international literature on the action of phlebotropic drugs and classified them according to the level of proof of their efficacy using the methodology recommended by the Health Authorities. Three of these drugs were given a grade A recommendation by the international committee that presided these recommendations: calcium dobesilate, hydroxyethyl-rutoside and micronised purified flavonoid fraction. These structural changes have without doubt had a considerable impact on patients with vein disease who are seeking care and on the treatment they can benefit from. In order to verify this hypothesis, a study corresponding to the implementation in France of the "Veinoconsult" research programme validated by the scientific council of the International Union of Phlebology (IUP) was carried out. This study has already taken place in different countries whose national phlebology societies belong to this organization. The aim of the study was to determine: - the prevalence of vein disease in patients consulting GPs; - the proportion of patients whose vein disease was treated effectively or not; - reasons why certain patients were no longer treated; - the clinical status of those currently being treatment; - the quality of life and the diagnostic and therapeutic resources that patients benefit from today; - and the stage of vein disease at which patients are now referred to angio-phlebologists and vascular surgeons.