Introduction
Management of population health has primarily been concerned with the control of chronic illnesses such as diabetes, heart disease, obesity, hypertension, and chronic respiratory illnesses. Although it is imperative for the management of population health to address the control of these illnesses, there is another chronic vascular condition that affects many and that has not received as much consideration. This condition is chronic venous disease (CVD).
Chronic venous disease is a collective term for the many conditions that occur when the veins of the legs are unable to adequately transport blood back to the heart. If it is not addressed, what can begin as mild pain and swelling of the legs, as well as varicosities (varicose veins), can become a lifelong struggle with pain and disability from venous ulcers. CVD leads to a decline in the overall health of the patient and results in increased spending on healthcare and lost time due to CVD.
Chronic venous disease should be included in the considerations of the management of population health as the healthcare system pivots to a model of value-based care and preventive medicine. Earlier intervention and improved patient education on chronic venous disease have the potential to decrease the long-term costs of healthcare.
Early evaluation by a qualified vein specialist plays an important role in preventing chronic venous disease from progressing to more serious complications. Individuals experiencing symptoms such as leg swelling, heaviness, or varicose veins may benefit from choosing to get treated by a board-certified vein surgeon in Alliance, where personalized treatment plans and minimally invasive procedures can help improve long-term vascular health.
How Chronic Venous Disease Develops
One-way valves prevent blood from flowing in the wrong direction and assist the venous system in returning blood back to the heart. When injury occurs to these valves and they become weakened, blood can flow and collect in the legs and lead to increased pressure that, in turn, results in chronic venous disease.
At first, chronic venous disease can appear as achy legs after standing, heavier feeling legs, swollen ankles, leg cramps that occur at night, itching, or spider veins. More serious cases can include chronic swelling and inflammation, as well as more prominent varicose veins and venous ulcers.
Many people think that the slow deterioration of their legs is just a natural sign of aging. This is also the common belief for the appearance of spider veins. Because of this, it is often perceived that there is no need for treatment. Delay in treatment usually results in complications that are harder to manage.
Chronic venous disease is underreported and widespread
Chronic venous disease is one of the most common global vascular diseases affecting each age group. Its occurrence increases as age increases. Women are the most affected group, yet men are still at risk.
Chronic venous disease is caused by several factors, including obesity, pregnancy, family history, age, reduced physical activity, deep vein thrombosis, and prolonged standing or sitting. Prolonged standing is a requirement of several jobs, including teaching, retail, health care, driving, and factory jobs.
For a disease that is so widespread, it is underreported considering its prevalence when compared to other chronic diseases.
Why Population Health Should Prioritize This Disease
Chronic venous disease is a perfect example of a disease that needs early intervention for treatment and a high level of education and management for the patient, which are the focus of population health management.
When diagnosed early, symptoms and disease progression can be managed with conservative measures such as exercise, weight management, and compression therapy, and supported with minimally invasive procedures, thereby decreasing the risk of developing complications.
Procrastination on managing the disease increases its severity, which subsequently increases the demand for healthcare, costs of treatment, prolongs recovery, and decreases quality of life.
Integrating the management of chronic disease with the care of venous health may provide better outcomes and decrease the costs to the healthcare system.
The Economic Burden of Delayed Care
More and more healthcare systems are adopting a preventive approach to care to decrease their costs.
Chronic venous disease may present with symptoms that are mild and even trivial, but, if left untreated, the disease will progress to a stage that is much more difficult and even expensive to treat. Advanced venous insufficiency can require numerous physician appointments, complicated and expensive wound care, unnecessary diagnostic imaging and medications, and bulky compression therapy supplies that are also expensive.
Chronic venous disease may also lead to the development of venous leg ulcers, which are extremely resource intensive and can last for months.
There are many indirect costs, such as a loss of productivity and increased sick leave due to poor leg health and pain and even early retirement due to these health issues.
There is a strong case, both clinically and economically, for early treatment of venous disease.
Quality of Life Often Suffers
Chronic venous disease is underestimated when its effects on quality of life are considered, especially when compared to heart disease or diabetes.
Chronic venous disease may progress to the point where even basic daily functions such as going to work and exercising, can be painful and disrupted. Chronic swelling can make choosing an outfit very difficult and even encourage a person to avoid going out. The swelling, combined with the variable disease, can have significant effects on a person’s confidence and emotional health.
As symptoms intensify, patients tend to reduce their physical activity, creating a vicious cycle that increases the likelihood of developing unhealthy weight, potential heart issues, and an even greater decline in overall health.
Supporting the health of the veins entails relieving symptoms and improving mobility, independence, emotional health, and supporting healthy aging.
The First Step in Prevention is Education
One of the best ways to improve the outcome of chronic venous disease is to increase the public’s knowledge.
Most patients are unaware of symptoms that alert them to the presence of a disease or that treatments are available.
Informational campaigns should instruct the public to be evaluated for chronic venous disease if they have symptoms of leg heaviness, leg pain, leg swelling, varicose veins, changes in the skin color of the leg, chronic wounds, or ulcerative wounds of the leg.
The public should also be informed of the importance that a healthy lifestyle plays in sustaining healthy circulation. This includes regular walking, healthy body weight, active body posture by avoiding long periods of stillness, leg elevation, and compression garments.
During regular preventive appointments, routine conversations should be the first step in supporting healthy veins.
Modern Advances in Vein Care
The past twenty years have seen an explosive growth in the number of treatments available for chronic venous disease.
In the past, the only option was to have a hospital stay for major vein surgery. Today, there are a number of outpatient, minimally invasive procedures that use local anesthesia.
Unlike the past, when recovery was lengthy, modern techniques such as endovenous laser therapy, radiofrequency ablation, foam sclerotherapy, and ambulatory phlebectomy have revolutionized care for the patient.
Within days of having one of these procedures, patients can resume their normal lifestyle and have excellent outcomes.
It is crucial to provide access to these treatment options in order to promote the health of the population.
Integrating Specialists into Coordinated Care
Population health management relies on the collaboration of an array of physicians. In this case, primary care, vascular, and cardiology specialists, along with endocrinologists, wound care, physical therapy, and preventive medicine, each provide important services.
This is especially true for patients with diabetes and obesity, as well as those suffering from peripheral vascular disease or restricted mobility, who may require a specialized vascular assessment as part of their holistic care.
Patients with chronic symptoms may benefit from having a thorough vascular assessment and may also require an ultrasound of the veins, along with a treatment plan that is tailored to them, from a vein specialist.
Coordinated care offers the necessary interventions at the right time for the patient, and also improves care continuity.
Technology Is Supporting Earlier Diagnosis
The improvement of health technologies is aiding in the diagnosis and management of chronic venous disease.
The use of high-resolution duplex ultrasound allows the physician precise evaluation of flow and function of veins and their valves of veins, making this technique the gold standard in diagnostic imaging.
The integration of electronic health records may allow the physician to easily identify patients with multiple vascular risk factors and may enable increased access for specialists in underserved communities due to the use of telehealth.
In the near future, the combination of artificial intelligence and predictive analytics may allow for earlier identification of high-risk patients in order to facilitate disease prevention and promote better health within the population.
Technology as the primary intervention is not the goal of modern health care, but modern health care thrives on the integration of technology, especially in the management of a population’s health.
The future of health care is focused on the establishment of systems to manage the health of the population by preventing chronic disease and reducing complications.
Chronic venous disease opens the door to effective preventative care programs. The treatments work, and understanding the disease and its risk factors leads to better outcomes with earlier treatment.
Healthcare models will focus more on providing appropriate vascular screening and education, understanding the value of mindfulness and collaboration across disciplines, and providing individualized care.
Value-based care encourages investment in preventative vein care. It is a win for both the patient and the system.
Conclusion
Chronic venous disease needs to be recognized as an important progressive systemic disease. It impacts millions on every level including physically, mentally, and financially. It is one of the most common diseases, yet is almost completely ignored in public health initiatives.
The more we raise awareness, properly and timely diagnose, and provide multidisciplinary coordinated care and treatment options, the better the long-term outcomes for the patient and the health system. Delay in treatment of chronic venous disease adds a higher burden to the health system. There is a clear need to incorporate vein health into preventative care options.
Chronic venous disease has a high impact on the community. Having it in focus with other progressive diseases will help the community have a strong health system.
