General practitioners (GPs) are responsible for the care of patients in the community, and are, therefore, charged with guaranteeing the continuity of care of patients discharged from hospital.
The GP has an important role in VTE management. Minor orthopaedic and trauma patients are quickly discharged by hospitals frequently with a prescription of DVT prophylaxis.
Maximal VTE risk is in the first 2–3 weeks after trauma or surgery but the risk lasts for 2–3 months [1
]. This is a period where patients are mainly followed by a GP who is in first line in recognizing initial DVT-PE signs. Thus, a specific attention to VTE problems is, today more than ever, fundamental in the GP’s knowledge.
In fact, the GP is defined as the medical guarantor of patient health, starting from the basal fundamental actions necessary to keep as smooth as possible the process of homecare. The fundamental importance of GPs lies in the fact that they have a long-term relationship, not only with individual patients, but also with their close relatives, and they are, therefore, well informed as regards family, as well as personal history of illness, in addition to issues such as reliability, compliance, socioeconomic standing, and living arrangements. The GP is also seen as the ‘case manager’ in cases of domiciliary care.
In our specific context, the GP and the attending physician or surgeon must collaborate to ensure continuity of care before, during and after hospital treatment. The GP is, therefore, charged with providing the attending physician or surgeon with all the information they need to ensure that the patient can be treated with as few complications as possible. To this end, information technology tools are extremely helpful, particularly if the GP highlights relevant information in a patient’s records, thereby facilitating the triage procedure. Indeed, it is fundamental that in the case of scheduled hospitalization the GP is aware of the individual risk factors of the patient and records them appropriately so they are readily available for consultation upon admission. In this way, the attending physician or surgeon can weigh up the specific risks linked to the reasons for hospitalization alongside those presented by these patient-related factors. This will give them an accurate idea of the total risk the patient is likely to be exposed to, and help them choose the appropriate treatment strategy accordingly.
Once the patient is discharged from hospital, and therefore, re-entrusted to the care of the GP, the latter will need to monitor the patient’s progress and ensure that she/he adhere to the prescribed treatment, not only in terms of dosage and duration, but also in terms of behavioural compliance, as well as being on the look out for any delayed complications. This is especially true in the present hospital practice, where many elective surgeries are rapidly completed, sometimes even on an outpatient basis. Bearing in mind the key role of GPs, this intersociety consensus statement was drawn up to give them the best possible support in deciding whether or not to prescribe treatment in cases where there is no established risk/benefit ratio, and therefore, no clear guidelines. Although the same paucity of evidence also prevented us from making firm recommendations, having reviewed the literature and drawn on the combined experience of the working group participants, we are in a position to advise the clinician to consider whether such treatment may be necessary for the patient.