Abstract
BackgroundLittle is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample.MethodsCross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding.ResultsICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment.ConclusionsOur findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
Highlights
Our findings suggest that intensive care unit (ICU) treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life
[1] this was associated with a growing number of patients suffering from long-term physical and neuropsychiatric impairments, which were recently summarized under the term postintensive care syndrome (PICS). [1, 2] While the exact prevalence of PICS is unknown, it is estimated that associated impairments occur in at least 1 of 4 survivors of critical illness and intensive care. [3,4,5] Short- and long-term impairments in quality of life and a significant socioeconomic burden in survivors of critical illness have previously been demonstrated. [6,7,8] The evidence regarding post-ICU follow-up strategies is conflicting—a recent systematic review and meta-analysis has found that the overall quality of evidence was low, and that follow-up interventions did not demonstrate any relevant effect on quality of life
We found that ICU treatment is associated with a 13.7% reduction of health-related quality of life (EQ-5D index value) and a higher probability of impairments in self-care and usual activities within the first year following critical illness
Summary
Intensive care unit (ICU) treatment has become more effective, and the related inpatient and post-discharge mortality has declined in several Western countries. [1] this was associated with a growing number of patients suffering from long-term physical and neuropsychiatric impairments, which were recently summarized under the term postintensive care syndrome (PICS). [1, 2] While the exact prevalence of PICS is unknown, it is estimated that associated impairments occur in at least 1 of 4 survivors of critical illness and intensive care. [3,4,5] Short- and long-term impairments in quality of life and a significant socioeconomic burden in survivors of critical illness have previously been demonstrated. [6,7,8] The evidence regarding post-ICU follow-up strategies is conflicting—a recent systematic review and meta-analysis has found that the overall quality of evidence was low, and that follow-up interventions did not demonstrate any relevant effect on quality of life. [9] Several studies have shown that ICU treatment is associated with increased healthcare resource utilization and costs. [10,11,12,13,14,15,16,17,18] there are only few studies on the associated utilization of outpatient health services, specialist consultations. [18] The German healthcare system consists of statutory public health insurance with mostly free choice of treatment providers, which offers a good opportunity to examine the use of healthcare services by ICU survivors. [19] we used data from a German population-based study, the Study of Health in Pomerania (SHIP), to examine the association of ICU treatment with outpatient health services utilization, costs, and health-related quality of life. [1, 2] While the exact prevalence of PICS is unknown, it is estimated that associated impairments occur in at least 1 of 4 survivors of critical illness and intensive care. [3,4,5] Short- and long-term impairments in quality of life and a significant socioeconomic burden in survivors of critical illness have previously been demonstrated. [19] we used data from a German population-based study, the Study of Health in Pomerania (SHIP), to examine the association of ICU treatment with outpatient health services utilization, costs, and health-related quality of life. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample
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