Utilization of outpatient treatment of deep vein thrombosis and barriers to its use

Excerpt

Low-molecular-weight heparins (LMWH) have been available on the U.S. market for over a decade, and enoxaparin specifically has been shown to be safe and effective for treating deep vein thrombosis (DVT) on an outpatient basis. Outpatient DVT management improves quality of life and is more cost-effective than hospitalization. Despite this evidence and the availability of an anticoagulation clinic within our health-system, clinical pharmacists anecdotally observed that outpatient DVT treatment was underutilized. The purpose of this study was to assess the current utilization of outpatient DVT treatment, identify factors present in patients hospitalized for treatment versus outpatient management, and survey physicians regarding the barriers to outpatient treatment. Data was collected retrospectively through a review of medical records for all adult patients admitted to the emergency department or the hospital with a primary diagnosis of DVT without pulmonary embolism during the period of June 2005 to June 2006. A total of 81 cases of DVT were identified of which 17% received outpatient management, 30% were discharged early on LMWH, and 53% had a full hospital stay for DVT treatment. Bleeding risk factors varied only slightly between groups with a mean number of risk factors of 1.4 in the outpatient group, 0.9 in the early discharge group, and 1.9 in the full hospital stay group. Of the patients admitted with DVT, only 33% had a documented reason for hospitalization. Thus, there were 67% of patients eligible for outpatient treatment that did not receive it. This lead to an average length of stay of 4.1 days in patients receiving early discharge and 8.7 days in those receiving complete hospital management compared the less than 24 hour stay of those seen in the emergency department and sent home for outpatient treatment. Physician surveys revealed opinions and barriers regarding outpatient DVT management. In summary, there is a significant lack of utilization of outpatient DVT management within our health-system and a number of barriers to overcome to improve compliance. The results of this retrospective study and survey are being used to educate the healthcare professionals on the optimal management of DVT and assess potential cost-savings as well as explore opportunities to formalize outpatient DVT management within our health-system. …