Approche organisationnelle et économique en France du traitement ambulatoire des neutropénies fébriles

Abstract

A NEW OBJECTIVE: Keeping neutropenic patients with fever in their homes helps to preserve their quality of life and reduces the costs. However, it is important to specify the conditions and the means necessary for the organisation so that home treatment can be applied safely because of the high risk of morbidity due to infection. THE FUNDAMENTAL CONDITIONS FOR ITS MANAGEMENT: The patients who could potentially benefit from an outpatient treatment strategy when presenting with neutropenia and fever must not have a tumour progressing and must not exhibit signs of co-morbidity and be affected by neutropenia and fever at home. Moreover, full information and the patient's and relatives' consent, a hospital nearby, the permanent presence of someone with the patient, the possibility of a telephone contact, the patient's full compliance, prior consent and excellent communication and excellent patient-physician relationship are all essential conditions. THE PARTICIPANTS AT HOME: The patient is essentially followed-up by the treating physician. Private nurses can intervene at the patient's home. Hospitalisation at home is presently the only alternative medical structure to classical hospitalisation. The development of nursing networks ensure the continuity between the hospital and the town and the good coordination of the health workers caring for the patient. The steps to be taken during an episode of fever are debated: complete discharge from hospital for some, initial outpatient controls in the hospital for several hours for others and the initial hospitalisation for 24 to 72 hours for some others. Whatever the case, haemocultures must be performed before the initiation of any antibiotherapy. The optimal clinical surveillance is ensured daily by a private nurse and the treating physician. An assessment every 2 to 3 days in a hospital unit is recommended. CARE NETWORKS: Their development should increase and hence create the continuity between the hospital and the town. The outpatient management of neutropenia with fever is a major source of economy; it allows the patients to be kept at home whilst ensuring the quality and security of their treatment.