A Survey to Assess Primary Care Physician Awareness of Complications Following Critical Illness

Abstract

Background: Survivors of critical illness are at risk for post-intensive care syndrome (PICS, comprised of physical dysfunction, cognitive impairment, and neuropsychiatric disorders including anxiety, depression, and post-traumatic stress). Their family members and caregivers are at risk for PICS-F (PICS-family, comprised of anxiety, depression, post-traumatic stress). PICS and PICS-F are increasingly recognized in critical care; however, the awareness among primary providers of the domains and the terms of PICS/PICS-F is unknown. Objectives: To determine current practice patterns and knowledge among primary care physicians in regards to patients recovering from critical illness; to determine barriers to care of post-critically ill patients. Methods: A paper and electronic survey were developed and randomly distributed to a subset of North Carolina primary care physicians. Survey questions consisted of the following domains: demographics, current practice, barriers to providing care, knowledge of common issues/complications following critical illness, and interest in changing care for survivors of critical illness. Results: One hundred and ninety-six surveys were delivered and 77 completed surveys (39% response rate) were analyzed. Respondents confirmed significant barriers to care of post-critically ill patients including lack of awareness of PICS/PICS-F terminology, insufficient time to spend with patients, and inadequate education of patients/families about recovery after critical illness. Fifty-seven percent of respondents thought a specialized transitional post-ICU clinic would be helpful. Sixty-two percent reported feeling comfortable caring for patients after a critical illness and 75% felt they were aware of common problems encountered after critical illness. However, 84% also thought more education about PICS/PICS-F would be helpful as would a list of common problems seen after critical illness (91%). Conclusions: Significant gaps and barriers to providing optimal post-ICU care by PCPs exist. Providers identified time constraints and educational gaps as domains needing attention. Dedicated post-ICU clinics might provide a bridge to transition care post-critical illness back to primary care providers.

The Experiences of Family Members of Patients Discharged from Intensive Care Unit: A Systematic Review of Qualitative Studies

“…Future research should focus on the development of a screening tool aimed at the early identification of family caregivers at risk of developing health problems, providing them with timely support [ 6 , 28 ]. Primary healthcare professionals should have a comprehensive understanding of caregiving-related stress and assess its impact on caregivers’ well-being [ 11 ]. Needham et al’s study asserts that guidelines have been developed for the overall assessment of caregivers [ 5 ].…”

“…In primary care settings, the healthcare professionals should play a role in identifying and coordinating the treatment of these symptoms, referring caregivers, for example, to a social worker or psychotherapist. Recent studies highlight that many primary care physicians may not be familiar with the specific needs of these caregivers [ 11 ]. To further improve the understanding of the different challenges and needs of family caregivers, it is necessary to understand how the diverse experiences of post-ICU family members may vary based on ethnic, socioeconomic, and cultural contexts.…”

“…However, identifying the risk factors for PICS-F is challenging, which makes it difficult to detect high-risk families and provide targeted interventions. There is a lack of awareness among primary care physicians and hospital professionals regarding the psychological experiences of family members of ICU survivors [ 11 ]. A deeper understanding of family experiences and their real needs can contribute to strengthening family-centered care and reducing the symptoms of PICS-F in the long term.…”

Health system approaches to providing posthospital care for survivors of sepsis and critical illness

“…An observational study found that, among patients receiving any HHC, those receiving both early home healthcare nursing visit (within 2 days of discharge) and outpatient clinician visit (within 7 days) experienced 41% lower 30-day rehospitalization compared to patients not receiving both elements of timely follow-up [11]. However, primary care clinicians report multiple barriers to delivery of optimal care of critical illness survivors including time constraints, education gaps, and incomplete information transfer of hospitalization records [14,15]. Current work exploring an intervention to support the delivery of postsepsis care through HHC and primary care is ongoing and will likely produce results generalizable to critical illness beyond sepsis [16 && ].…”