Comprehensive Outpatient Management of Low-Risk Pulmonary Embolism: Can Primary Care Do This? A Narrative Review.
Publisher DOI
PubMed ID
32240089
Abstract
INTRODUCTION
The evidence for outpatient management of hemodynamically stable, low-risk patients with acute symptomatic pulmonary embolism (PE) is mounting. Guidance in identifying patients who are eligible for outpatient (ambulatory) care is available in the literature and society guidelines. Less is known about who can identify patients eligible for outpatient management and in what clinical practice settings.
OBJECTIVE
To answer the question, "Can primary care do this?" (provide comprehensive outpatient management of low-risk PE).
METHODS
We undertook a narrative review of the literature on the outpatient management of acute PE focusing on site of care. We searched the English-language literature in PubMed and Embase from January 1, 1950, through July 15, 2019.
RESULTS
We identified 26 eligible studies. We found no studies that evaluated comprehensive PE management in a primary care clinic or general practice setting. In 19 studies, the site-of-care decision making occurred in the Emergency Department (or after a short period of supplemental observation) and in 7 studies the decision occurred in a specialty clinic. We discuss the components of care involved in the diagnosis, outpatient eligibility assessment, treatment, and follow-up of ambulatory patients with acute PE.
DISCUSSION
We see no formal reason why a trained primary care physician could not provide comprehensive care for select patients with low-risk PE. Leading obstacles include lack of ready access to advanced pulmonary imaging and the time constraints of a busy outpatient clinic.
CONCLUSION
Until studies establish safe parameters of such a practice, the question "Can primary care do this?" must remain open.
The evidence for outpatient management of hemodynamically stable, low-risk patients with acute symptomatic pulmonary embolism (PE) is mounting. Guidance in identifying patients who are eligible for outpatient (ambulatory) care is available in the literature and society guidelines. Less is known about who can identify patients eligible for outpatient management and in what clinical practice settings.
OBJECTIVE
To answer the question, "Can primary care do this?" (provide comprehensive outpatient management of low-risk PE).
METHODS
We undertook a narrative review of the literature on the outpatient management of acute PE focusing on site of care. We searched the English-language literature in PubMed and Embase from January 1, 1950, through July 15, 2019.
RESULTS
We identified 26 eligible studies. We found no studies that evaluated comprehensive PE management in a primary care clinic or general practice setting. In 19 studies, the site-of-care decision making occurred in the Emergency Department (or after a short period of supplemental observation) and in 7 studies the decision occurred in a specialty clinic. We discuss the components of care involved in the diagnosis, outpatient eligibility assessment, treatment, and follow-up of ambulatory patients with acute PE.
DISCUSSION
We see no formal reason why a trained primary care physician could not provide comprehensive care for select patients with low-risk PE. Leading obstacles include lack of ready access to advanced pulmonary imaging and the time constraints of a busy outpatient clinic.
CONCLUSION
Until studies establish safe parameters of such a practice, the question "Can primary care do this?" must remain open.
Date Issued
2020
Publication Type
Article
Language(s)
en
Author(s)
Vinson, David R | |
Geersing, Geert-Jan | |
Roy, Pierre-Marie |
Additional Credits
Journal
The Permanente journal
Publisher
The Permanente Federation
ISSN
1552-5767
Access(Rights)
restricted