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Docherty C, Quasim T, MacTavish P, Devine H, O'Brien P, Strachan L, Lucie P, Hogg L, Shaw M, McPeake J. Anxiety and depression following critical illness: A comparison of the recovery trajectories of patients and caregivers. Aust Crit Care 2024:S1036-7314(24)00084-5. [PMID: 38797584 DOI: 10.1016/j.aucc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/01/2024] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Following critical illness, family members are often required to adopt caregiving responsibilities. Anxiety and depression are common long term problems for both patients and caregivers. However, at present, it is not known how the trajectories of these symptoms compare between patients and caregivers. OBJECTIVES The aim of this study was to investigate and compare the trajectories of anxiety and depression in patients and caregivers in the first year following critical illness. METHODS This study analyses data from a prospective multicentre cohort study of patients and caregivers who underwent a complex recovery intervention following critical illness. Paired patients and caregivers were recruited. The Hospital Anxiety and Depression Scale was used to evaluate symptoms of anxiety and depression at three timepoints: baseline; 3 months; and 12 months in both patient and caregivers. A linear mixed-effects regression model was used to evaluate the trajectories of these symptoms over the first year following critical illness. RESULTS 115 paired patients and caregivers, who received the complex recovery intervention, were recruited. There was no significant difference in the relative trajectory of depressive symptoms between patients and caregivers in the first 12 months following critical illness (p = 0.08). There was, however, a significant difference in the trajectory of anxiety symptoms between patients and caregivers during this time period (p = 0.04), with caregivers seeing reduced resolution of symptoms in comparison to patients. CONCLUSIONS Following critical illness, symptoms of anxiety and depression are common in both patients and caregivers. The trajectory of symptoms of depression was similar between caregivers and patients; however, there was a significantly different recovery trajectory in symptoms of anxiety. Further research is required to understand the recovery pathway of caregivers in order to design effective interventions.
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Affiliation(s)
- Christie Docherty
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Helen Devine
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Peter O'Brien
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, North Lanarkshire, UK
| | - Lucy Hogg
- Intensive Care Unit, Victoria Hospital, Kirkcaldy, UK
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
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McPeake J, Iwashyna TJ, MacTavish P, Devine H, Henderson P, Quasim T, Shaw M. Could an integrated model of health and social care after critical illness reduce socioeconomic disparities in outcomes? A Bayesian analysis. BJA OPEN 2024; 9:100259. [PMID: 38322488 PMCID: PMC10844938 DOI: 10.1016/j.bjao.2024.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
Background There is limited evidence to understand what impact, if any, recovery services might have for patients across the socioeconomic spectrum after critical illness. We analysed data from a multicentre critical care recovery programme to understand the impact of this programme across the socioeconomic spectrum. Methods The setting for this pre-planned secondary analysis was a critical care rehabilitation programme-Intensive Care Syndrome: Promoting Independence and Return to Employment. Data were collected from five hospital sites running this programme. We utilised a Bayesian approach to analysis and explore any possible effect of the InS:PIRE intervention on Health-Related Quality of Life (HRQoL) across the socioeconomic gradient. A Bayesian quantile, non-linear mixed effects regression model, using a compound symmetry covariance structure, accounting for multiple timepoints was utilised. The Scottish Index of Multiple Deprivation (SIMD) was used to measure socioeconomic status and HRQoL was measured using the EQ-5D-5L. Results In the initial baseline cohort of 182 patients, 55% of patients were male, the median age was 58 yr (inter-quartile range: 50-66 yr) and 129 (79%) patients had two or more comorbidities at ICU admission. Using the neutral prior, there was an overall probability of intervention benefit of 100% (β=0.71, 95% credible interval: 0.34-1.09) over 12 months to those in the SIMD≤3 cohort, and an 98.6% (β=-1.38, 95% credible interval: -2.62 to -0.16) probability of greater benefit (i.e. a steeper increase in improvement) at 12 months in the SIMD≤3 vs SIMD≥4 cohort in the EQ-visual analogue scale. Conclusions Using multicentre data, this re-analysis suggests, but does not prove, that an integrated health and social care intervention is likely to improve outcomes across the socioeconomic gradient after critical illness, with a potentially greater benefit for those from deprived communities. Future research designed to prospectively analyse how critical care recovery programmes could potentially improve outcomes across the socioeconomic gradient is warranted.
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Affiliation(s)
- Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | | | - Pamela MacTavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Helen Devine
- Crosshouse University Teaching Hospital, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Phil Henderson
- Royal Alexandria Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK
| | - Martin Shaw
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
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Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
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Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
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Bottom-Tanzer SF, Poyant JO, Louzada MT, Abela D, Boudouvas A, Poon E, Power L, Kim WC, Hojman HM, Bugaev N, Johnson BP, Bawazeer MA, Mahoney EJ. Longitudinal study evaluating post-ICU syndrome differences between acute care surgery and trauma SICU survivors. J Trauma Acute Care Surg 2023; 95:893-898. [PMID: 37314426 DOI: 10.1097/ta.0000000000003977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Post-intensive care unit (ICU) syndrome (PICS) occurs at an exorbitant rate in surgical ICU (SICU) survivors. It remains unknown if critical illness due to trauma versus acute care surgery (ACS) may represent different pathophysiologic entities. In this longitudinal study, we determined if admission criteria in a cohort of trauma and ACS patients were associated with differences in the occurrence of PICS. METHODS Patients were 18 years or older, admitted to a Level I trauma center to the trauma or ACS services, remained in the SICU for ≥72 hours, and were seen in an ICU Recovery Center at 2 weeks, 12 weeks, and 24 weeks after hospital discharge. Post-ICU syndrome sequelae were diagnosed by dedicated specialist staffing using clinical criteria and screening questionnaires. The PICS symptoms were distilled into physical, cognitive, and psychiatric categories. Preadmission histories, hospital courses, and recovery data were collected via retrospective chart review. RESULTS One hundred twenty-six patients were included: 74 (57.3%) trauma patients and 55 (42.6%) ACS patients. Prehospital psychosocial histories were similar between groups. Acute care surgery patients had a significantly longer hospital course, higher APACHE II and III scores, were intubated for longer, and had higher rates of sepsis, acute renal failure, open abdomen, and hospital readmissions. At the 2-week follow-up visit, ACS patients had higher rates of PICS sequelae (ACS, 97.8% vs. trauma 85.3%; p = 0.03), particularly in the physical (ACS, 95.6% vs. trauma 82.0%, p = 0.04), and psychiatric domains (ACS, 55.6% vs. trauma 35.0%, p = 0.04). At the 12-week and 24-week visits, rates of PICS symptoms were comparable between groups. CONCLUSION The occurrence of PICS is extraordinarily high in both trauma and ACS SICU survivors. Despite entering the SICU with similar psychosocial histories, the two cohorts have different pathophysiologic experiences, which are associated with a higher rate of impairment in the ACS patients during early follow-up. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Samantha F Bottom-Tanzer
- From the Tufts University School of Medicine & Tufts Graduate School of Biomedical Sciences (S.F.B.-T., D.A., L.P.); Department of Pharmacy (J.O.P.), Tufts Medical Center; Department of General Surgery, Tufts Medical Center (M.T.L.), Tufts University School of Medicine,; Department of Physical and Occupational Therapy (A.B., E.P.), Tufts Medical Center; Division of Trauma & Acute Care Surgery (W.C.K., H.M.H., N.B., B.P.J., M.A.B.), Tufts Medical Center, Tufts University School of Medicine, Boston; and Division of Surgical Critical Care (E.J.M.), Lahey Hospital & Medical Center, Burlington, Massachusetts
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Harrod M, Hauschildt K, Kamphuis LA, Korpela PR, Rouse M, Nallamothu BK, Iwashyna TJ. Disrupted Lives: Caregivers' Experiences of In-Hospital Cardiac Arrest Survivors' Recovery 5 Years Later. J Am Heart Assoc 2023; 12:e028746. [PMID: 37671627 PMCID: PMC10547269 DOI: 10.1161/jaha.122.028746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 09/06/2023]
Abstract
Background Survivors of in-hospital cardiac arrest (IHCA) experience ongoing physical and cognitive impairments, often requiring support from a caregiver at home afterwards. Caregivers are important in the survivor's recovery, yet there is little research specifically focused on their experiences once the survivor is discharged home. In this study, we highlight how caregivers for veteran IHCA survivors described and experienced their caregiver role, the strategies they used to fulfill their role, and the additional needs they still have years after the IHCA event. Methods and Results Between March and July 2019, semistructured telephone interviews were conducted with 12 caregivers for veteran IHCA survivors. Interviews were transcribed, and content analysis was performed. Patterns within the data were further analyzed and grouped into themes. A predominant theme of "disruption" was identified across 3 different domains including the following: (1) disruption in caregiver's life, (2) disruption in caregiver-patient relationship, and (3) disruption in caregiver's well-being. Disruption was associated with both positive and negative caregiver experiences. Strategies caregivers used and resources they felt would have helped them adjust to their caregiver role were also identified. Conclusions Caregivers for veteran IHCA survivors experienced a disruption in many facets of their lives. Caregivers felt the veterans' IHCA impacted various aspects of their lives, and they continued to need additional support in order to care for the IHCA survivor and themselves. Although some were able to procure coping strategies, such as counseling and engaging in stress-relieving activities, most indicated additional help and resources were still needed.
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Affiliation(s)
- Molly Harrod
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Katrina Hauschildt
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Department of SociologyPopulation Studies CenterUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Lee A. Kamphuis
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Peggy R. Korpela
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Marylena Rouse
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMIUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Theodore J. Iwashyna
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Health Policy and Management, School of Public HealthThe Johns Hopkins UniversityBaltimoreMDUSA
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Boehm LM, Danesh V, Eaton TL, McPeake J, Pena MA, Bonnet KR, Stollings JL, Jones AC, Schlundt DG, Sevin CM. Multidisciplinary ICU Recovery Clinic Visits: A Qualitative Analysis of Patient-Provider Dialogues. Chest 2023; 163:843-854. [PMID: 36243061 PMCID: PMC10258431 DOI: 10.1016/j.chest.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Research confirms the heterogeneous nature of patient challenges during recovery from the ICU and supports the need for modifying care experiences, but few data are available to guide clinicians seeking to support patients' individual recovery trajectories. RESEARCH QUESTION What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU recovery clinic (ICU-RC)? STUDY DESIGN AND METHODS We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the southeastern United States. The sample included 19 patients and 13 caregivers (≥ 18 years of age) attending a telemedicine ICU-RC visit after critical illness resulting from septic shock or ARDS. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches. RESULTS Two themes were identified from the patient-provider dialogue: (1) problem identification and (2) problem-solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health-care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance. INTERPRETATION Patients surviving a critical illness experience a complexity of problems that may be addressed best by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues, we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03926533; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN; Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN.
| | - Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX
| | - Tammy L Eaton
- National Clinician Scholars Program, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, University of Michigan, Ann Arbor, MI; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, England
| | - Maria A Pena
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Kemberlee R Bonnet
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Joanna L Stollings
- Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN; Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN
| | - Carla M Sevin
- Critical Illness, Brain Dysfunction, Survivorship Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Eaton TL, Lewis A, Donovan HS, Davis BC, Butcher BW, Alexander SA, Iwashyna TJ, Scheunemann LP, Seaman J. Examining the needs of survivors of critical illness through the lens of palliative care: A qualitative study of survivor experiences. Intensive Crit Care Nurs 2023; 75:103362. [PMID: 36528461 DOI: 10.1016/j.iccn.2022.103362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the needs of adult survivors of critical illness through a lens of palliative care. RESEARCH METHODOLOGY A qualitative study of adult survivors of critical illness using semi-structured interviews and framework analysis. SETTING Participants were recruited from the post-intensive care unit clinic of a mid-Atlantic academic medical center in the United States. FINDINGS Seventeen survivors of critical illness aged 34-80 (median, 66) participated in the study. The majority of patients were female (64.7 %, n = 11) with a median length of index ICU stay of 12 days (interquartile range [IQR] 8-19). Interviews were conducted February to March 2021 and occurred a median of 20 months following the index intensive care stay (range, 13-33 months). We identified six key themes which align with palliative care principles: 1) persistent symptom burden; 2) critical illness as a life-altering experience; 3) spiritual changes and significance; 4) interpreting/managing the survivor experience; 5) feelings of loss and burden; and 6) social support needs. CONCLUSION Our findings suggest that palliative care components such as symptom management, goals of care discussions, care coordination, and spiritual and social support may assist in the assessment and treatment of survivors of critical illness.
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Affiliation(s)
- Tammy L Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; National Clinician Scholars Program (NCSP), Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Anna Lewis
- School of Public Health, Department of Health Policy and Management, University of Pittsburgh, PA, USA; Care Management Department, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, USA
| | - Heidi S Donovan
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA
| | - Brian C Davis
- School of Law, Duquesne University, Pittsburgh, PA, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sheila A Alexander
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Leslie P Scheunemann
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Seaman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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8
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McHenry RD, Moultrie CEJ, Quasim T, Mackay DF, Pell JP. Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis. Crit Care Med 2023; 51:347-356. [PMID: 36728845 DOI: 10.1097/ccm.0000000000005765] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care. DATA SOURCES A systematic search of CINAHL, Ovid MEDLINE, and EMBASE was undertaken on September 13, 2022. STUDY SELECTION Observational cohort studies of adults assessing the association between socioeconomic status and critical care outcomes including mortality, length of stay, and functional outcomes were included. Two independent reviewers assessed titles, abstracts, and full texts against eligibility and quality criteria. DATA EXTRACTION Details of study methodology, population, exposure measures, and outcomes were extracted. DATA SYNTHESIS Thirty-eight studies met eligibility criteria for systematic review. Twenty-three studies reporting mortality to less than or equal to 30 days following critical care admission, and eight reporting length of stay, were included in meta-analysis. Random-effects pooled analysis showed that lower socioeconomic status was associated with higher mortality at less than or equal to 30 days following critical care admission, with pooled odds ratio of 1.13 (95% CIs, 1.05-1.22). Meta-analysis of ICU length of stay demonstrated no significant difference between socioeconomic groups. Socioeconomic status may also be associated with functional status and discharge destination following ICU admission. CONCLUSIONS Lower socioeconomic status was associated with higher mortality following admission to critical care.
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Affiliation(s)
- Ryan D McHenry
- ScotSTAR, Scottish Ambulance Service, Glasgow, United Kingdom
| | | | - Tara Quasim
- School of Medicine, Dentistry & Nursing, Academic Unit of Anaesthesia, Critical Care and Perioperative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Henderson P, Quasim T, Shaw M, MacTavish P, Devine H, Daniel M, Nicolson F, O'Brien P, Weir A, Strachan L, Senior L, Lucie P, Bollan L, Duffty J, Hogg L, Ross C, Sim M, Sundaram R, Iwashyna TJ, McPeake J. Evaluation of a health and social care programme to improve outcomes following critical illness: a multicentre study. Thorax 2023; 78:160-168. [PMID: 35314485 PMCID: PMC9872253 DOI: 10.1136/thoraxjnl-2021-218428] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/10/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE At present, clinicians aiming to support patients through the challenges after critical care have limited evidence to base interventions. OBJECTIVES Evaluate a multicentre integrated health and social care intervention for critical care survivors. A process evaluation assessed factors influencing the programme implementation. METHODS This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme. We compared patients who attended this programme with a usual care cohort from the same time period across nine hospital sites in Scotland. The primary outcome was health-related quality of life (HRQoL) measured via the EuroQol 5-dimension 5-level instrument, at 12 months post hospital discharge. Secondary outcome measures included self-efficacy, depression, anxiety and pain. RESULTS 137 patients who received the InS:PIRE intervention completed outcome measures at 12 months. In the usual care cohort, 115 patients completed the measures. The two cohorts had similar baseline demographics. After adjustment, there was a significant absolute increase in HRQoL in the intervention cohort in relation to the usual care cohort (0.12, 95% CI 0.04 to 0.20, p=0.01). Patients in the InS:PIRE cohort also reported self-efficacy scores that were 7.7% higher (2.32 points higher, 95% CI 0.32 to 4.31, p=0.02), fewer symptoms of depression (OR 0.38, 95% CI 0.19 to 0.76, p=0.01) and similar symptoms of anxiety (OR 0.58, 95% CI 0.30 to 1.13, p=0.11). There was no significant difference in overall pain experience. Key facilitators for implementation were: integration with inpatient care, organisational engagement, flexibility to service inclusion; key barriers were: funding, staff availability and venue availability. CONCLUSIONS This multicentre evaluation of a health and social care programme designed for survivors of critical illness appears to show benefit at 12 months following hospital discharge.
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Affiliation(s)
- Philip Henderson
- Academic unit of Anaesthesia, Critical Care, and Peri-operative Medicine, University of Glasgow, Glasgow, UK
| | - Tara Quasim
- Academic unit of Anaesthesia, Critical Care, and Peri-operative Medicine, University of Glasgow, Glasgow, UK
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Martin Shaw
- Academic unit of Anaesthesia, Critical Care, and Peri-operative Medicine, University of Glasgow, Glasgow, UK
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Pamela MacTavish
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Helen Devine
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Malcolm Daniel
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Fiona Nicolson
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Peter O'Brien
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Ashley Weir
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Crosshouse, Kilmarnock, UK
| | - Laura Strachan
- Department of Intensive Care Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Lorraine Senior
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Monklands, Airdrie, UK
| | - Phil Lucie
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Wishaw, North Lanarkshire, UK
| | - Lynn Bollan
- Department of Intensive Care Medicine, Adult Critical Care Unit, University Hospital Wishaw, North Lanarkshire, UK
| | - Jane Duffty
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Hairmyres, East Kilbride, UK
| | - Lucy Hogg
- Department of Intensive Care Medicine, Victoria Hospital, Kirkcaldy, UK
| | - Colette Ross
- Department of Intensive Care Medicine, Victoria Hospital, Kirkcaldy, UK
| | - Malcolm Sim
- Department of Intensive Care Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Radha Sundaram
- Department of Intensive Care Medicine, Royal Alexandra Hospital, Paisley, UK
| | - Theodore J Iwashyna
- Department of Pulmonary and Critical Care, Ann Arbor Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Joanne McPeake
- Academic unit of Anaesthesia, Critical Care, and Peri-operative Medicine, University of Glasgow, Glasgow, UK
- Department of Intensive Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
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10
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Evolution in Care Delivery within Critical Illness Recovery Programs during the COVID-19 Pandemic: A Qualitative Study. Ann Am Thorac Soc 2022; 19:1900-1906. [PMID: 35731631 PMCID: PMC9667813 DOI: 10.1513/annalsats.202203-255oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: There are limited data on the impact of the coronavirus disease (COVID-19) pandemic on intensive care unit (ICU) recovery clinic care delivery practices. Objectives: We sought to better understand the patient-level factors affecting ICU recovery clinic care and changing clinical thinking during the COVID-19 pandemic. We also sought to understand how the COVID-19 pandemic sparked innovation within ICU recovery clinics. Methods: A multicenter qualitative study was conducted with ICU recovery clinic interprofessional clinicians involved with the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. Data were collected using semistructured interviews and were analyzed using thematic analysis. Key themes were organized in a working analytical framework. Results: Twenty-nine participants from 15 international sites participated in the study. Participants identified three patient-level key themes that influenced care delivery in ICU recovery programs: 1) social isolation, 2) decreased emotional reserve in patients and families, and 3) substantial social care needs. Changes in ICU recovery clinic care delivery occurred at both the clinician level (e.g., growing awareness of healthcare disparities and inequities, recognition of financial effects of illness, refinement of communication skills, increased focus on reconstructing the illness narrative) and the practice level (e.g., expansion of care delivery modes, efforts to integrate social care) in response to each of the patient-level themes. Identified gaps in ICU recovery clinic care delivery during the COVID-19 pandemic included a need for multidisciplinary team members, access to care issues (e.g., digital poverty, health insurance coverage, language barriers), and altered family engagement. Conclusions: This study demonstrates that addressing patient-level factors such as efforts to integrate social care, address financial needs, refine provider communication skills (e.g., empathic listening), and enhance focus on reconstructing the illness narrative became important priorities during the ICU recovery clinic visit during the COVID-19 pandemic. We also identified several ongoing gaps in ICU recovery clinic care delivery that highlight the need for interventions focused on the integration of social and clinic services for critical care survivors.
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11
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Jain S, Hauschildt K, Scheunemann LP. Social determinants of recovery. Curr Opin Crit Care 2022; 28:557-565. [PMID: 35993295 DOI: 10.1097/mcc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine evidence describing the influence of social determinants on recovery following hospitalization with critical illness. In addition, it is meant to provide insight into the several mechanisms through which social factors influence recovery as well as illuminate approaches to addressing these factors at various levels in research, clinical care, and policy. RECENT FINDINGS Social determinants of health, ranging from individual factors like social support and socioeconomic status to contextual ones like neighborhood deprivation, are associated with disability, cognitive impairment, and mental health after critical illness. Furthermore, many social factors are reciprocally related to recovery wherein the consequences of critical illness such as financial toxicity and caregiver burden can put essential social needs under strain turning them into barriers to recovery. SUMMARY Recovery after hospitalization for critical illness may be influenced by many social factors. These factors warrant attention by clinicians, health systems, and policymakers to enhance long-term outcomes of critical illness survivors.
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12
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McPeake J, Boehm L, Hibbert E, Hauschildt K, Bakhru R, Bastin A, Butcher B, Eaton T, Harris W, Hope A, Jackson J, Johnson A, Kloos J, Korzick K, McCartney J, Meyer J, Montgomery-Yates A, Quasim T, Slack A, Wade D, Still M, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna T, Haines K, Sevin C. Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study. BMJ Open 2022; 12:e060454. [PMID: 36167379 PMCID: PMC9516069 DOI: 10.1136/bmjopen-2021-060454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness. DESIGN In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections. SETTING 14 hospital sites in the USA, UK and Australia. PARTICIPANTS Patients and caregivers, who had been admitted to critical care from three continents. RESULTS 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems. CONCLUSIONS Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one's social network, economic security and access to healthcare is required following discharge from critical care.
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Affiliation(s)
- Joanne McPeake
- Critical Care, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
- Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Leanne Boehm
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health Foundation, Sunshine, Victoria, Australia
| | - Katrina Hauschildt
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Rita Bakhru
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anthony Bastin
- Department of Peri-operative Medicine, Barts Health NHS Trust, London, UK
| | - Brad Butcher
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tammy Eaton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, Michigan, US
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, US
| | - Wendy Harris
- Intensive Care Unit, University College London, London, UK
| | - Aluko Hope
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - James Jackson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Annie Johnson
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet Kloos
- Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Karen Korzick
- Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Joel Meyer
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tara Quasim
- Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Andrew Slack
- Department of Critical Care, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Dorothy Wade
- Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary Still
- Critical Care, Emory University Hospital, Atlanta, Georgia, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
- Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore Iwashyna
- Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan, USA
| | - Kimberley Haines
- Department of Physiotherapy, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Carla Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Hauschildt KE, Hechtman RK, Prescott HC, Cagino LM, Iwashyna TJ. Interviews with primary care physicians identify unmet transition needs after ICU. Crit Care 2022; 26:248. [PMID: 35971153 PMCID: PMC9376575 DOI: 10.1186/s13054-022-04125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
AIM We sought to explore unmet needs in transitions of care for critical illness survivors that concern primary care physicians. FINDINGS Semi-structured interviews with primary care physicians identified three categories of concerns about unmet transition needs after patients' ICU stays: patients' understanding of their ICU stay and potential complications, treatments or support needs not covered by insurance, and starting and maintaining needed rehabilitation and assistance across transitions of care. CONCLUSION Given current constraints of access to coordinated post-ICU care, efforts to identify and address the post-hospitalization needs of critical illness survivors may be improved through coordinated work across the health system.
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Affiliation(s)
- Katrina E Hauschildt
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Rachel K Hechtman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Leigh M Cagino
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Theodore J Iwashyna
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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14
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McPeake J, Henderson P, MacTavish P, Devine H, Daniel M, Lucie P, Bollan L, Hogg L, MacMahon M, Mulhern S, Murray P, O'Neill L, Strachan L, Iwashyna TJ, Shaw M, Quasim T. A multicentre evaluation exploring the impact of an integrated health and social care intervention for the caregivers of ICU survivors. Crit Care 2022; 26:152. [PMID: 35610616 PMCID: PMC9128318 DOI: 10.1186/s13054-022-04014-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Caregivers and family members of Intensive Care Unit (ICU) survivors can face emotional problems following patient discharge from hospital. We aimed to evaluate the impact of a multi-centre integrated health and social care intervention, on caregiver and family member outcomes.
Methods This study evaluated the impact of the Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) programme across 9 sites in Scotland. InS:PIRE is an integrated health and social care intervention. We compared caregivers who attended this programme with a contemporary control group of ICU caregivers (usual care cohort), who did not attend. Results The primary outcome was anxiety measured via the Hospital Anxiety and Depression Scale at 12 months post-hospital discharge. Secondary outcome measures included depression, carer strain and clinical insomnia. A total of 170 caregivers had data available at 12 months for inclusion in this study; 81 caregivers attended the InS:PIRE intervention and completed outcome measures at 12 months post-hospital discharge. In the usual care cohort of caregivers, 89 completed measures. The two cohorts had similar baseline demographics. After adjustment, those caregivers who attended InS:PIRE demonstrated a significant improvement in symptoms of anxiety (OR: 0.42, 95% CI: 0.20–0.89, p = 0.02), carer strain (OR: 0.39; 95% CI: 0.16–0.98 p = 0.04) and clinical insomnia (OR: 0.40; 95% CI: 0.17–0.77 p < 0.001). There was no significant difference in symptoms of depression at 12 months.
Conclusions This multicentre evaluation has shown that caregivers who attended an integrated health and social care intervention reported improved emotional health and less symptoms of insomnia, 12 months after the delivery of the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04014-z.
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Affiliation(s)
- Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK. .,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Philip Henderson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Helen Devine
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Malcolm Daniel
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, Wishaw, UK
| | - Lynn Bollan
- Intensive Care Unit, University Hospital Wishaw, Wishaw, UK
| | - Lucy Hogg
- Intensive Care Unit, NHS Fife, Kirkcaldy, UK
| | | | - Sharon Mulhern
- Intensive Care Unit, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Pauline Murray
- Intensive Care Unit, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Laura O'Neill
- Intensive Care Unit, University Hospital Monklands, Airdrie, UK
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Theodore J Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.,Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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15
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The Prevalence of Spiritual and Social Support Needs and Their Association With Postintensive Care Syndrome Symptoms Among Critical Illness Survivors Seen in a Post-ICU Follow-Up Clinic. Crit Care Explor 2022; 4:e0676. [DOI: 10.1097/cce.0000000000000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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16
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Abstract
The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.
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17
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MacTavish P, McPeake J, Breslin A, Forrest R, Kishore R, MacGregor F, Oprey A, Quasim T, Shaw M. Evaluation of medication changes following severe COVID-19 infection: a multicentre evaluation. BMJ Open Respir Res 2021; 8:8/1/e001037. [PMID: 34872966 PMCID: PMC8650475 DOI: 10.1136/bmjresp-2021-001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Critically ill patients often experience several transitions of care following critical illness. Research has explored the challenges which patients have with medication management across these transitions. It is unclear whether patients admitted to critical care due to COVID-19 will have similar challenges. The aim of this study was to explore medication management in critical care survivors following severe COVID-19. Methods Between 3 and 7 months post hospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. During the clinic consultation a medication review was performed by a pharmacist. This included medicines reconciliation, assessing the appropriateness of each of the prescribed medications and identification of medication changes. We also assessed changes to pain management in the discharge period. Results In total, 78 patients had a full medication review available. Over 70% of patients were taking an increased dose of medicine or a new medicine at clinic. There was a significant overall increase in new medication during the clinic consultation, across different British National Formulary classifications (OR: 1.73 (95% CI: 1.28 to 2.34), p<0.001). Compared with pre critical care admission, there was a significant increase in the number of patients taking regular analgesia following severe COVID-19 infection (23 (29.5%) vs 39 (50%), p<0.001). Conclusion Following severe COVID-19, patients may require new or increasing doses of medicines. Ongoing review of these patients is crucial to ensure optimal outcomes.
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Affiliation(s)
- Pamela MacTavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK .,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Antoin Breslin
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Ruth Forrest
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rakesh Kishore
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Fiona MacGregor
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alison Oprey
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin Shaw
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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18
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McPeake J, Sevin CM, Mikkelsen ME. Functional outcomes following critical illness: epidemiology, current management strategies and the future priorities. Curr Opin Crit Care 2021; 27:506-512. [PMID: 34267076 DOI: 10.1097/mcc.0000000000000856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intensive care unit (ICU) survivorship has gained significant attention over the course of the COVID-19 pandemic. In this review, we summarize the contemporary literature in relation to the epidemiology and management of post-ICU problems. RECENT FINDINGS Survivors of critical illness can have complex physical, social, emotional and cognitive needs in the months following hospital discharge. Emerging evidence has shown that pre-ICU characteristics such as educational attainment, alongside in-ICU factors such as delirium, may contribute to worsening outcomes. Evidence regarding the impact of post-ICU recovery services is evolving, but models such as post-ICU clinics and peer support programs are gaining rapid momentum. SUMMARY Future research should focus on modifiable risk factors and how identification and treatment of these can improve outcomes. Furthermore, rigorous evaluation of postacute critical care recovery services is necessary.
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Affiliation(s)
- Joanne McPeake
- NHS Greater Glasgow and Clyde, University of Glasgow, School of Medicine, Dentistry and Nursing, THIS Institute (University of Cambridge), Cambridge, UK
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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19
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Iwashyna TJ, Kamphuis LA, Gundel SJ, Hope AA, Jolley S, Admon AJ, Caldwell E, Monahan ML, Hauschildt K, Thompson BT, Hough CL. Continuing Cardiopulmonary Symptoms, Disability, and Financial Toxicity 1 Month After Hospitalization for Third-Wave COVID-19: Early Results From a US Nationwide Cohort. J Hosp Med 2021; 16:jhm.3660. [PMID: 34424190 DOI: 10.12788/jhm.3660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients discharged after COVID-19 report ongoing needs. OBJECTIVES To measure incident symptoms after COVID-19 hospitalization. DESIGN, SETTING, AND PARTICIPANTS Preplanned early look at 1-month follow-up surveys from patients hospitalized August 2020 to January 2021 in NHLBI PETAL Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. English- or Spanish-speaking hospitalized adults without substantial pre-COVID-19 disability with a positive molecular test for SARS-CoV-2. RESULTS Overall, 253 patients were hospitalized for a median of 5 days (interquartile range [IQR], 3-8), and had a median age of 60 years (IQR, 45-68). By race/ethnicity, 136 (53.8%) were non-Hispanic White, 23 (9.1%) were non-Hispanic Black, and 83 (32.8%) were Hispanic. Most (139 [54.9%]) reported a new or worsened cardiopulmonary symptom, and 16% (n = 39) reported new or increased oxygen use; 213 (84.2%) patients reported not feeling fully back to their pre-COVID-19 level of functioning. New limitations in activities of daily living were present in 130 (52.8%) patients. Financial toxicities, including job loss or change (49 [19.8%]), having a loved one take time off (93 [37.8%]), and using up one's savings (58 [23.2%]), were common. Longer lengths of hospital stay were associated with greater odds of 1-month cardiopulmonary symptoms (adjusted odds ratio [aOR], 1.82 per additional week in the hospital; 95% CI, 1.11-2.98) and new disability (aOR, 2.06; 95% CI, 1.21-3.53). There were not uniform demographic patterns of association. LIMITATIONS We prioritized patients' reports of their own incident problems over objective testing. CONCLUSION Patients who survived COVID-19 in the United States during late 2020/early 2021 still faced new burdens 1 month after hospital discharge.
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Affiliation(s)
- Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lee A Kamphuis
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Stephanie J Gundel
- Department of Emergency Medicine, Harborview Medical Center, Seattle, Washington
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, New York
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon
| | - Sarah Jolley
- Division of Pulmonary and Critical Care, University of Colorado, Denver, Colorado
| | - Andrew J Admon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ellen Caldwell
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Washington, Seattle, Washington
| | - Max L Monahan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Katherine Hauschildt
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University School of Medicine, Portland, Oregon
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20
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McPeake J, Iwashyna TJ, Henderson P, Leyland AH, Mackay D, Quasim T, Walters M, Harhay M, Shaw M. Long term outcomes following critical care hospital admission: A prospective cohort study of UK biobank participants ✰,★. THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100121. [PMID: 34291229 PMCID: PMC8278491 DOI: 10.1016/j.lanepe.2021.100121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND : This study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. A secondary aim was to examine the interrelationship between emotional, physical, and social problems during recovery. METHODS : We utilised data from the UK Biobank, an on-going, prospective population-based cohort study. We employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital (first admission to hospital available) without critical care. Structural equation modelling was used to analyse emotional, physical and social outcomes following critical illness and the relationships between these health domains. FINDINGS : Data from 1,618 patients were analysed. The median time to follow-up in the critical care cohort was 4427 days (IQR:788-6146) vs 4516 days (IQR: 811-6369) in the non-critical care, hospitalised cohort. Across the two time periods assessed (pre and post 2000), patients exposed to critical care were more likely to experience mental health issues such as depression (p < 0.01) and social isolation (p = 0.01) following discharge from hospital. The critical care cohort were also more likely to have social problems such as the requirement for government funded welfare support (p = 0.02). In the critical care cohort, social and emotional health were closely correlated (p < 0.001, 95% CI:0.33-0.54). The nature of physical problems changed over time; pre-2000 there was a significant difference between the critical and non-critical care in physical outcomes following discharge from hospital, however, there was no difference detected between the two cohorts post-2000. INTERPRETATION This cohort study has demonstrated that survivors of critical illness have different psycho-social outcomes to matched patients, hospitalised without a critical care encounter. FUNDING JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). AHL is part of the Social and Public Health Sciences Unit, funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
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Affiliation(s)
- Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Theodore J Iwashyna
- Centre for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, United States of America
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Philip Henderson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Daniel Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Michael Harhay
- Department of Biostatistics, Epidemiology, and Informatics; and Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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21
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Long-term Outcomes Following Severe COVID-19 Infection: A Multicenter Cohort Study of Family Member Outcomes. Ann Am Thorac Soc 2021; 18:2098-2101. [PMID: 34192506 PMCID: PMC8641813 DOI: 10.1513/annalsats.202104-481rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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McPeake J, Quasim T, Henderson P, Leyland AH, Lone NI, Walters M, Iwashyna TJ, Shaw M. Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study. Chest 2021; 160:1681-1692. [PMID: 34153342 PMCID: PMC9199363 DOI: 10.1016/j.chest.2021.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background Survivors of critical illness have poor long-term outcomes with subsequent increases in health care utilization. Less is known about the interplay between multimorbidity and long-term outcomes. Research Question How do baseline patient demographics impact mortality and health care utilization in the year after discharge from critical care? Study Design and Methods Using data from a prospectively collected cohort, we used propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital without critical care. Long-term mortality was examined via nationally linked data as was hospital resource use in the year after hospital discharge. The cause of death was also examined. Results This analysis included 3,112 participants. There was no difference in long-term mortality between the critical care and hospital cohorts (adjusted hazard ratio, 1.09; 95% CI, 0.90-1.32; P = .39). Prehospitalization emotional health issues (eg, clinical diagnosis of depression) were associated with increased long-term mortality (hazard ratio, 1.49; 95% CI, 1.14-1.96; P < .004). Health care utilization was different between the two cohorts in the year after discharge with the critical care cohort experiencing a 29% increased risk of hospital readmission (OR, 1.29; 95% CI, 1.11-1.50; P = .001). Interpretation This national cohort study has demonstrated increased resource use for critical care survivors in the year after discharge but fails to replicate past findings of increased longer-term mortality. Multimorbidity, lifestyle factors, and socioeconomic status appear to influence long-term outcomes and should be the focus of future research.
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Affiliation(s)
- Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK, Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.
| | - Philip Henderson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, UK, NHS Lothian, UK.
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Theodore J Iwashyna
- Centre for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan, United States of America, Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America.
| | - Martin Shaw
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
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23
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Ringdal M, Bergbom I, Nilsson J, Karlsson V. Older patients' recovery following intensive care: A follow-up study with the RAIN questionnaire. Intensive Crit Care Nurs 2021; 65:103038. [PMID: 33775549 DOI: 10.1016/j.iccn.2021.103038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/10/2021] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
The aim was to investigate older patient recovery (65 years+) up to two years following discharge from an intensive care unit (ICU) using the Recovery After Intensive Care (RAIN) instrument and to correlate RAIN with the Hospital Anxiety and Depression Scale (HAD). METHODS An explorative and descriptive longitudinal design was used. Eighty-two patients answered RAIN and HAD at least twice following discharge. Demographic and clinical data were collected from patient records. RESULTS Recovery after the ICU was relatively stable and good for older patients at the four data collection points. There was little variation on the RAIN subscales over time. The greatest recovery improvement was found in existential ruminations from 2 to 24 months. A patient that could look forward and those with supportive relatives had the highest scores at all four measurements. Having lower financial situation was correlated to poorer recovery and was significant at 24 months. The RAIN and HAD instruments showed significant correlations, except for the revaluation of life subscale, which is not an aspect in HAD. CONCLUSION The RAIN instrument shows to be a good measurement for all dimensions of recovery, including existential dimensions, which are not covered by any other instrument.
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Affiliation(s)
- M Ringdal
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Kungälvs Hospital, Sweden.
| | - I Bergbom
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden, Professor Emerita, Honorary Doctor at Åbo Academy, Åbo, Finland
| | - J Nilsson
- Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden
| | - V Karlsson
- Department of Health Science, University West, Trollhättan, Sweden
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24
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Rousseau AF, Prescott HC, Brett SJ, Weiss B, Azoulay E, Creteur J, Latronico N, Hough CL, Weber-Carstens S, Vincent JL, Preiser JC. Long-term outcomes after critical illness: recent insights. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:108. [PMID: 33731201 PMCID: PMC7968190 DOI: 10.1186/s13054-021-03535-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 02/08/2023]
Abstract
Intensive care survivors often experience post-intensive care sequelae, which are frequently gathered together under the term “post-intensive care syndrome” (PICS). The consequences of PICS on quality of life, health-related costs and hospital readmissions are real public health problems. In the present Viewpoint, we summarize current knowledge and gaps in our understanding of PICS and approaches to management.
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Affiliation(s)
- Anne-Françoise Rousseau
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Liège, Belgium
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephen J Brett
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elie Azoulay
- Réanimation Médicale, Hôpital St Louis, Paris, France
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicola Latronico
- Department of Anesthesiology, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.,Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Erasme University Hospital, Route de Lennik 808, Brussels, Belgium.
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25
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Provision of holistic care after severe COVID-19 pneumonia. THE LANCET RESPIRATORY MEDICINE 2021; 9:e24. [PMID: 33556320 PMCID: PMC7906750 DOI: 10.1016/s2213-2600(21)00019-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
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26
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Robinson C, Hibbert E, Bastin AJ, Meyer J, Montgomery-Yates A, Quasim T, Slack A, Mikkelsen ME, Iwashyna TJ, Haines KJ, Sevin CM, McPeake J, Boehm LM. An International Study Exploring the Experience of Survivors of Critical Illness as Volunteers Within ICU Recovery Services. Crit Care Explor 2020; 2:e0273. [PMID: 34124686 DOI: 10.1097/cce.0000000000000273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles. We sought to explore the experience of survivors of critical illness, as volunteers, involved in ICU recovery services and understand their motivation for undertaking these roles. Design Qualitative exploration using in-depth semistructured interviews. The study design used an inductive content analysis process. We also documented the roles that were adopted by volunteers in each site involved in the study. Setting Patients and caregivers were sampled from seven sites across three continents. Patients and Subjects Patients and caregivers who had adopted peer-volunteering roles were undertaken. Interventions None. Measurements and Main Results Twelve patient and caregiver peer volunteers were interviewed. Four key themes were identified. These themes related to the experience of volunteers within ICU recovery services and their motivation for undertaking these roles: 1) self-belief and acceptance, 2) developing peer support, 3) social roles and a sense of purpose, and 4) giving back. Overwhelmingly, participants were positive about the role of the volunteer in the critical care setting. Conclusions Peer volunteers undertake a variety of roles in ICU recovery services and during recovery more generally. These roles appear to be of direct benefit to those in these roles. Future research is needed to develop these roles and fully understand the potential impact on the service, including the impact on other patients.
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Affiliation(s)
- Carly Robinson
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Anthony J Bastin
- Department of Perioperative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Joel Meyer
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Slack
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.,School of Physiotherapy, The University of Melbourne, VIC, Australia
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN.,Cognitive Impairment, Brain dysfunction, and Survivorship (CIBS) Center at Vanderbilt, Nashville, TN
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27
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Hauschildt KE, Seigworth C, Kamphuis LA, Hough CL, Moss M, McPeake JM, Iwashyna TJ. Financial Toxicity After Acute Respiratory Distress Syndrome: A National Qualitative Cohort Study. Crit Care Med 2020; 48:1103-1110. [PMID: 32697479 PMCID: PMC7387748 DOI: 10.1097/ccm.0000000000004378] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The financial burdens and subsequent related distress of medical care, referred to as financial toxicity, may limit access to beneficial treatments. However, financial toxicity after acute care is less described-and may be an important but underexplored mechanism preventing full recovery after critical illnesses such as acute respiratory distress syndrome. We sought to identify the mechanisms by which financial toxicity manifested in patients with acute respiratory distress syndrome, protective factors against such toxicity, and the consequences of financial toxicity to survivors' lives following acute respiratory distress syndrome. DESIGN We conducted semistructured interviews following patients' hospitalization and during recovery as an ancillary study to a multicenter randomized clinical trial in acute respiratory distress syndrome. Patients were 9-16 months post randomization at the time of interview. SETTING AND PARTICIPANTS The Reevaluation Of Systemic Early Neuromuscular Blockade trial examined the use of early neuromuscular blockade in mechanically ventilated patients with moderate/severe acute respiratory distress syndrome. We recruited consecutive surviving patients who were English speaking, consented to follow-up, and were randomized between December 11, 2017, and May 4, 2018 (n = 79) from 29 U.S. sites. MEASUREMENTS AND MAIN RESULTS We asked about patients' perceptions of financial burden(s) that they associated with their acute respiratory distress syndrome hospitalization. Forty-six of 79 eligible acute respiratory distress syndrome survivors (58%) participated (from 22 sites); their median age was 56 (interquartile range 47-62). Thirty-one of 46 reported at least one acute respiratory distress syndrome-related financial impact. Financial toxicity manifested via medical bills, changes in insurance coverage, and loss of employment income. Respondents reported not working prior to acute respiratory distress syndrome, using Medicaid or Medicare, or, conversely, generous work benefits as factors which may have limited financial burdens. Patients reported multiple consequences of acute respiratory distress syndrome-related financial toxicity, including harms to their mental and physical health, increased reliance on others, and specific material hardships. CONCLUSIONS Financial toxicity related to critical illness is common and may limit patients' emotional, physical, and social recovery after acute respiratory distress syndrome hospitalization for at least a year.
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Affiliation(s)
- Katrina E Hauschildt
- Department of Sociology, College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Claire Seigworth
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI
| | - Lee A Kamphuis
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI
| | - Catherine L Hough
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA
| | - Marc Moss
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Joanne M McPeake
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, United Kingdom
| | - Theodore J Iwashyna
- Institute for Social Research, University of Michigan, Ann Arbor, MI
- Veterans Affairs Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, MI
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
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28
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Medication-related Problems in Intensive Care Unit Survivors: Learning from a Multicenter Program. Ann Am Thorac Soc 2020; 17:1326-1329. [PMID: 32716636 PMCID: PMC7640628 DOI: 10.1513/annalsats.202005-444rl] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Abstract
Supplemental Digital Content is available in the text. To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized.
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30
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Learning from Discharge Experiences of Intensive Care Unit Survivors and Their Families: Is Consistency a Solution? Ann Am Thorac Soc 2020; 16:1369-1371. [PMID: 31674819 DOI: 10.1513/annalsats.201908-603ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Eaton TL, McPeake J, Rogan J, Johnson A, Boehm LM. Caring for Survivors of Critical Illness: Current Practices and the Role of the Nurse in Intensive Care Unit Aftercare. Am J Crit Care 2019; 28:481-485. [PMID: 31676524 DOI: 10.4037/ajcc2019885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tammy L Eaton
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery.
| | - Joanne McPeake
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Julie Rogan
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Annie Johnson
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
| | - Leanne M Boehm
- Tammy L. Eaton is cofounder and lead advanced practice provider for the Critical Illness Recovery Center (CIRC) post-ICU clinic and codirector of the ICU Survivor and Family Peer Support and ICU journal programs at UPMC Mercy, a PhD student at the University of Pittsburgh School of Nursing, and an inpatient palliative care nurse practitioner, Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, Pennsylvania. Joanne McPeake is a nurse consultant in clinical research and innovation in NHS Greater Glasgow and Clyde and a senior clinical lecturer in the School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland. Julie Rogan is a clinical nurse specialist focused on implementation of ICU survivorship activities, including ICU diary and peer support programs. She is currently enrolled in the Doctor of Nursing Practice program at the University of Pennsylvania, Philadelphia. Annie Johnson is cochair of the Society of Critical Care Medicine (SCCM) Thrive Peer Support Collaborative and a bedside critical care nurse practitioner at Mayo Clinic in Rochester, Minnesota. Annie also coleads the Mayo Clinic ICU Recovery Program. Leanne Boehm is an assistant professor at Vanderbilt University and is interested in implementation of evidence-based practice and organizational factors that influence interprofessional efforts in the acute care setting. All authors are founding members of the Critical and Acute Illness Recovery Organization (CAIRO), an international consortium of active clinical programs working to advance the practice and science of critical and acute illness recovery
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