Development of medical indoor environment counseling interventions in Paris: A 5-year overview

For the past 20 years, the Paris municipal environmental health department (Service parisien de sante environnementale, SPSE) has been providing onsite free-of-charge, environmental interventions (audits) to Parisians whose physicians prescribe them for patients with a disease associated with their home environment. When necessary, these audits include measurements of chemical and microbiological pollutants so that patients can receive advice about reducing their exposure to the pollutants identified. Since 2017, the SPSE has added consultations at sites other than the patient's home to the range of its services of medical indoor environment counseling (MIEC): MIEC consultations provide the clientele with both an assessment of the risk factors that may be present in their homes and advice aimed at reducing the identified exposures, while environmental appraisals assess both home and occupational exposures to determine if a home-based audit is necessary. This article describes the changes over time of the 765 interventions (391 audits and 374 consultations) that took place from 2015 through 2019 and characterizes the prescribing physicians. In all, 391 audits have been performed for 426 Parisians, 39% of them children; they were prescribed mainly by pulmonologists and pediatricians, working both in hospitals and private practice, mainly in Paris. These doctors report that these audits enable them to know their patients' domestic exposure and thus provide them with appropriate advice. Since 2017, 64 Parisians, 30% of them children, have received 58 MIEC consultations, most often prescribed by general practitioners from private practice and community health centers in Paris. Since 2018, a partnership with Tenon Hospital (Paris, 20th district) has made it possible to provide 202 MIEC consultations and 114 environmental appraisals to 248 adult patients of the hospital's pulmonary department, living in Paris or its region. These interventions are preventive actions aiming to reduce exposure to indoor air pollution in homes. Public health would benefit from an increase in physicians' awareness of these services and their greater availability.