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Thromb Res. 2020 Jan 16;187:180-185. doi: 10.1016/j.thromres.2020.01.015. [Epub ahead of print]

Pulmonary embolism home treatment: What GP want?

Author information

1
Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France.
2
Department of biostatistics, Montpellier University Hospital, Montpellier, France.
3
Department of Medicine and Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada.
4
Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France; Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada. Electronic address: Jean-Philippe.Galanaud@sunnybrook.ca.

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.

KEYWORDS:

Ambulatory care; Anticoagulants; General practitioner; Patient pathway; Pulmonary embolism

Conflict of interest statement

Declaration of competing interest JP Galanaud received a research grant from Bayer to conduct the study. Other authors state that they have no conflicts to disclose in relation with this work.

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