Home care for acute pulmonary embolism: Feasibility and general practitioner acceptability

• Published in: Journal des maladies vasculaires Vol. 40; no. 4; p. 223
• Main Authors: Payerols-Ternisien, A, Meusy, A, Terminet, A, Pontal, D, Bourdin, A, Vergés, M, Sebbane, M, Georgesu, V, Aubas, P, Quéré, I, Mercier, G, Galanaud, J-P
• Format: Journal Article
• Language: French
• Published: France 01.07.2015
• Subjects: Adult; Aftercare; Ambulatory Care; Attitude of Health Personnel; Comorbidity; Feasibility Studies; Female; France; General Practitioners - psychology; Home Care Services; Humans; Inpatients - psychology; Length of Stay; Male; Middle Aged; Patient Acceptance of Health Care; Patient Selection; Patients - psychology; Prospective Studies; Pulmonary Embolism - therapy; Referral and Consultation; Telephone; France; Enquête d’opinion; Pulmonary embolism; Embolie pulmonaire; Opinion survey; Patient's pathway; Traitement ambulatoire; Médecin traitant; Maladie thromboembolique veineuse; Parcours de soins; Primary care; Ambulatory care
• ISSN: 2214-8116

In France, initial management of pulmonary embolism (PE) is performed in the hospital setting. The latest international guidelines suggest that PE at low risk of mortality can be treated in the ambulatory care setting. This means that ambulatory care pathways and general practitioner (GP) opinions concerning such a change in practice need to be determined. To determine: (1) rate of patients eligible for an ambulatory management of their PE and reasons for hospitalization of PE at low risk of mortality; (2) acceptability for GPs of PE home care and patient's desired care pathway. Two-part prospective observational study conducted in Montpellier University Hospital from May 2012 to August 2013: (1) in-hospital study including all consecutive patients with non-hospital acquired PE; (2) telephonic survey on PE patient's ambulatory care pathway conducted among GPs. In-hospital study: 99.1% (n=211) of included patients were hospitalized and only 14.1% (n=30) had all criteria for home care. Patient's pathway survey: 68.3% (n=112) of GPs, particularly those aged 40-54 years and those who had already managed patients alone after hospital discharge, were in favour of home care for PE. One hundred and thirty-nine (84.8%) GPs wanted a collaborative management with an expert thrombosis physician and an outpatient follow-up visit at one week. Few patients managed at Montpellier University Hospital are eligible for ambulatory management of their PE. GPs have a favorable opinion of home care for PE if it is conducted in collaboration with an expert thrombosis physician.