[Meaningful interventions for peripheral arterial disease: Stopping primary referral to the vascular surgeon and angioplasty].

Supervised exercise therapy with lifestyle counseling by a specialized physical therapist has replaced endovascular or open revascularization as primary treatment for intermittent claudication for most patients in the Netherlands. Succesful implementation of this guideline-recommended treatment strategy was achieved by warranting availability and quality of care by organizing care around a national network. Further reductions in unnecessary interventions in this population may be achieved when general practitioners and medical specialists collaborate, for instance by making in-hospital vascular diagnostic laboratories accessible for primary care. The implementation of similar interventions for other non-communicable chronic diseases such as chronic obstructive pulmonary disease or coronary heart disease in standard care is lacking, despite a solid evidence base and guideline recommendations.