A summary of new guidelines on the diagnosis and management of deep venous thrombosis (DVT) and pulmonary embolism appears in the Practice Guidelines section of this issue of American Family Physician.1 These recommendations have been formulated by a panel with representatives from the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP), and therefore have been constructed from a primary care perspective. The recommendations are based on solid, published evidence and a rigorous evidence-based approach. They represent multiple best practices: the best practice in clinical care, the use of evidence-based methodology for guideline development, and collaboration among two specialties and a federal agency dedicated to improving health care quality.
The diagnosis and treatment of DVT and pulmonary embolism is an evolving field, and guidelines on this topic must, by necessity, summarize and use the evidence at a set point in time. As with all clinical recommendations, these will need to be reviewed and updated periodically. Nevertheless, the guidelines, if adopted widely, have the potential not only to improve the quality of care, but also to make the diagnosis and treatment of DVT and pulmonary embolism much more consistent and cost-effective.
The use of low-molecular-weight heparin in the outpatient setting, when appropriate, can save considerable cost and inconvenience, while allowing for higher quality care. This is a win-win combination for patients, physicians, and payers. It also offers family physicians an added benefit—continuity with patients. As more payers and health care systems move to the use of hospitalists for inpatient care, family physicians face an added difficulty in maintaining continuity with our patients between the inpatient and outpatient settings. Outpatient treatment of thromboembolic disorders will eliminate the need to transfer care to and from other physicians for at least one common condition.
The members of the joint AAFP/ACP panel on DVT and pulmonary embolism, as well as the AAFP and ACP staff, deserve credit and appreciation for their time and effort on behalf of practicing primary care physicians and their patients. They have passed the ball to practicing family physicians and internists who now need to review, accept, and implement these guidelines.