Medical student's research at Gateway finds slightly higher level of arterial disease in Seaforth patients
Study is a first in rural Canada
By Susan Hundertmark, September 3, 2010, The Huron Expositor
Findings from a six-week research project done by a medical student working at Gateway Rural Health Research Institute on a silent condition that could cause strokes and heart attacks could soon be presented to rural physicians across Canada.
Dr. Claudio Munoz, research director at Gateway, says Akshay Shetty, a medical student going into his third year at the University of Western Ontario, discovered a slightly higher than normal rate of peripheral arterial disease in Seaforth patients over the age of 55 during a recent placement at Gateway.
"He worked on his own project. I set it up for him and he had a very good experience. He can now write up an abstract for publication and make a presentation to the Society of Rural Physicians of Canada," says Munoz. "Akshay now has a true understanding of the condition."
Using patients over 55 from the Seaforth doctors working at the Huron community Family Health Team, Shetty performed ankle brachial index (ABI) tests, which consist of measuring the blood pressure on arms and ankles to determine if there is a plaque buildup in the arteries that could cause heart attacks, stroke and death.
"It's a proven and effective test that tells how healthy the blood vessels are. Gateway tries to find chronic diseases that can have a big impact but are under-researched," says Shetty, adding that while peripheral arterial disease has been studied in the U.S., there is little research on the disease in Canada, especially with rural patients. One of the aims of the six-week study was to determine the importance of screening for the disease.
"Most people don't know they have it. They could be going about their daily life with no pain and no diagnosis and they have a heart attack," says Shetty, adding that the only indicator can be some pain in the legs. Smoking, an unhealthy diet, diabetes and high cholesterol can lead to the disease.
He says the ABI test is easy to perform by any doctor or nurse but adds that since a patient has to lie still for 10 minutes before the 10-minute test is done, family physicians would have to add 20 minutes to each clinic visit, possibly reducing their daily clinic load by 30 to 40 per cent.
"We were looking to find our why it isn't being done. One of the reasons is that doctors in Canada don't get reimbursed to do it and another reason is the time constraint," he says.
"ABI is underused in general and peripheral arterial disease is vastly underdiagnosed. This study has been done in the United States but never in a rural setting in Canada," says Shetty.
However, he says an "eye-popping" statistic is that once someone finds out they have the disease, the mortality rate is 50 per cent after 10 years without treatment and only 50 per cent of people with the disease are ever diagnosed.
While statistics show that at age 66, five to 11 per cent of patients have peripheral arterial disease, Shetty says 11.7 per cent of the Seaforth patients over 55 he screened had the disease.
"There is a tendency for it to be higher in rural areas," he says.
Shetty says once diagnosed, patients can get good results with aggressive treatment of high blood pressure, prescriptive exercise, stopping smoking and diabetes control.
"The big thing is to reduce the risk factors. It's very preventable," he says.
While Shetty had taken part in research involving video conferencing and surgery in rural areas during his first and second years of medical school, he said his experience with Gateway allowed him to see up close how communities benefit from medical research.
"I never got to go to the communities that would be effected and I realize now that you have to be in the community to do the research. In Seaforth, I got to work with the physicians and their patients in the community and it's a much more holistic view," he says.
Shetty says working with Gateway was one of the defining experiences for him that showed him he wants to work at a rural family medicine practice where he can also do research. Before his experience with Gateway, he thought it was only possible to do research in large urban academic centres.
"Gateway is the only one in Canada that operates on that level (in a rural area). It's refreshing and almost entrepreneurial and amazing to see the community support it gets. There is a tight connection between the community, the doctors and the hospital and Dr. Munoz," he says.
Munoz says medical students who do their rural placements in Seaforth are getting the chance to spend 40 per cent of their time doing research at Gateway and 60 per cent doing clinical work with family physicians.
"The idea is to implant the seeds of research so you can introduce research when you set up your practice in the future," he says, adding that Seaforth is seeing high quality medical students applying for placements because of the research component.
"Once medical students take ownership of a research project, they can do wonderful things. It's very rewarding to collect data to help your patients. And, you can also help your peers and colleagues across Canada and around the world," says Munoz.
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