Healthcare resource utilisation by critically ill older patients following an intensive care unit stay

Jeitziner, Marie‐Madlen; Zwakhalen, Sandra; Hantikainen, Virpi; Hamers, Jan P.H.

doi:10.1111/jocn.12749

Cited by 10 publications

(7 citation statements)

References 30 publications

(76 reference statements)

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“…[18] One study of critically ill older patients with a matched control group also reported more general practitioner consultations and higher medication intake for post-ICU subjects. [47] In contrast, another cohort study of post-ICU patients found no change in the number of general practitioner consultations or medications in the majority of the participants. [48]…”

Section: Discussionmentioning

confidence: 99%

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

et al. 2019

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BackgroundLittle is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample.MethodsCross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding.ResultsICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment.ConclusionsOur findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.

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Section: Discussionmentioning

confidence: 99%

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

et al. 2019

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“…ICU follow-up care has been suggested as a potential means to address the physical, cognitive and mental problems faced after discharge, but it is unknown which (combination of) interventions are most (cost)effective [7, 8]. Studies proposed that frequent visits to GPs allowed early recognition and proactive treatment of health problems that prevented further hospitalizations [28] and that the post-hospital collaboration among hospital, GP and community services regarding physical and neuropsychological rehabilitation should be strengthened [26]. A multi-centre study conducted in the Netherlands reported that, at three months after discharge, almost 70% of the ICU survivors had had contact with the GP.…”

Section: Discussionmentioning

confidence: 99%

Dutch ICU survivors have more consultations with general practitioners before and after ICU admission compared to a matched control group from the general population

et al. 2019

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Background General Practitioners (GPs) play a key role in the healthcare trajectory of patients. If the patient experiences problems that are typically non-life-threatening, such as the symptoms of post-intensive-care syndrome, the GP will be the first healthcare professional they consult. The primary aim of this study is to gain insight in the frequency of GP consultations during the year before hospital admission and the year after discharge for ICU survivors and a matched control group from the general population. The secondary aim of this study is to gain insight into differences between subgroups of the ICU population with respect to the frequency of GP consultations. Methods We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Clinical data of patients admitted to an ICU in 2013 were enriched with claims data from the years 2012, 2013 and 2014. Poisson regression was used to assess the differences in frequency of GP consultations between the ICU population and the control group. Results ICU patients have more consultations with GPs during the year before and after admission than individuals in the control group. In the last four weeks before admission, ICU patients have 3.58 (CI 3.37; 3.80) times more GP consultations than the control group, and during the first four weeks after discharge they have 4.98 (CI 4.74; 5.23) times more GP consultations. In the year after hospital discharge ICU survivors have an increased GP consultation rate compared to the year before their hospital admission. Conclusions Close to hospital admission and shortly after hospital discharge, the frequency of GP consultations substantially increases in the population of ICU survivors. Even a year after hospital discharge, ICU survivors have increased GP consultation rates. Therefore, GPs should be well informed about the problems ICU patients suffer after discharge, in order to provide suitable follow-up care.

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“…GPs should be extra alert after critical illness and use their holistic approach to diagnose or prevent possible symptoms in all three domains of PICS (physical, mental and cognitive). For this reason, GPs play a pivotal role in post-ICU care, as frequent visits to GPs might lead to early recognition and treatment [ 37 ]. Thereby, collaboration after hospital discharge among primary care, hospitals and community services should be strengthened [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

van Sleeuwen,

de Man,

Zegers

et al. 2023

European Journal of General Practice

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Background Patients experience long-lasting health problems defined as post-intensive care syndrome (PICS) after Intensive Care Unit (ICU) admission. Little is known about PICS in primary care. Objectives To investigate whether ICU survivors encounter more new International Classification of Primary Care-2 (ICPC-2) diagnoses and general practitioner (GP) contact compared to patients with similar comorbidity without ICU admission. Methods Prospective multicentre cohort study in three Dutch general practices. Numbers of disease-episodes and GP contacts of ICU survivors ≥ 16 years admitted between 2008 and 2017 were extracted from GPs’ information systems. A non-ICU reference cohort was matched 1:1 for age, sex, follow-up period and comorbidity groups from patients’ medical history. Negative binominal regression analysis was used to compare both cohorts 0–3, 3–6, 6–12 months, 1–2 and 2–5 years after ICU admission and 1 year prior to admission. Results ICU survivors ( n = 199) encountered more new disease-episodes 1 year before (mean 3.97 (95% confidence interval [CI] 3.50–4.52]]; reference 2.36 [1.28–3.17]) to 2–5 years after ICU admission (3.65 [3.15–4.26]; reference 2.86 [2.52–3.22]). ICU survivors also had more GP contacts 1 year before (mean 19.61 [17.31–22.17]; reference 10.02 [7.81–12.38]) to 2–5 years after ICU admission (18.53 [15.58–21.85]; reference 12.03 [10.33–13.91]). Patients with prior ICU admission did not encounter patterns in specific ICPC-2 chapters compared to non-ICU patients. Conclusion Patients admitted to the ICU encounter more new primary care disease-episodes and GP contacts. As patients present their symptoms to their GP first, it is therefore up to the GP to recognise these critical illness-related symptoms.

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Healthcare resource utilisation by critically ill older patients following an intensive care unit stay

Cited by 10 publications

References 30 publications

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life

Dutch ICU survivors have more consultations with general practitioners before and after ICU admission compared to a matched control group from the general population

Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

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