Pulmonary embolism home treatment: What GP want?. Issue 187 (March 2020)

• Record Type: Journal Article
• Authors: Calais, Clémence; Mercier, Grégoire; Meusy, Arthur; Le Collen, Lorris; Kahn, Susan R.; Quéré, Isabelle; Galanaud, Jean-Philippe
• Is Part Of: Thrombosis research. Issue 187(2020)
• Page Start: 180
• Page End: 185
• Publication Date: 2020-03
• Subjects: DOAC direct oral anticoagulants -- DVT deep vein thrombosis -- ER emergency room -- GP general practitioner -- LMWH low molecular weight heparin -- PE pulmonary embolism -- VTE venous thromboembolism; Pulmonary embolism -- Ambulatory care -- Patient pathway -- General practitioner -- Anticoagulants; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.01.015
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: In routine clinical practice, in most countries, patients with pulmonary embolism (PE) are hospitalized for clinical surveillance and to start anticoagulant treatment. Clinical trials and guidelines suggest that patients with stable PE can be safely treated as outpatients. This shift in management may increase general practitioners' (GP) role in PE early management. However, GP opinion regarding PE home treatment has never been assessed. Methods: Survey conducted in France among a random sample of 360 GP (564 contacted to reach targeted sample size) working in regions representative of national access to French healthcare system. Main objectives were to assess i) GP' acceptability to PE home treatment ii) GP' preferred outpatient pathway. Results: 87% of GP were favorable to home treatment of stable PE if the medical report is immediately available when the patient is discharged from ER (100%), in the absence of social and medical facility isolation of the patient (99%) and if the patient (99%) and GP (76%) consented. Outpatient pathways should be collaborative, between GP and a thrombosis specialist, and should include specialized follow-up visits at one week (80%), 3–6 months (80%) and when anticoagulant treatment is stopped (97%). 61% of GP felt that direct oral anticoagulants (DOAC) should facilitate PE home treatment, which should improve patient's quality of life. Conclusion: The vast majority of interviewed GP are favorable to home treatment of stable PE if a formal outpatient pathway is established. DOAC are perceived as another key for the success of the development of PE home treatment. Highlights: In routine practice, despite evidence from studies, most patients with PE are hospitalized. General practitioners' (GP) opinion regarding PE home treatment has never been specifically assessed. Large national phone survey conducted among a random selection of French GP. The vast majority of interviewed GP are favorable to PE home treatment if a formal outpatient pathway is established.