More than the tip of the iceberg: association between disabilities and inability to attend a clinic-based post-ICU follow-up and how it may impact on health inequalities

Rosa, Régis Goulart; Kochhann, Renata; Berto, Paula Pinheiro; Biason, Livia; Maccari, Juçara Gasparetto; León, Patricia de; Dutra, Francine Hoffmann; Silva, Sâmia Faria da; Sganzerla, Daniel; Schneider, Daniel; Cardoso, Paulo Ricardo Cerveira; Gomes, Frederico Klein; Machado, Vitória Homem; Medeiros, Gregory Saraiva; Tonietto, Túlio Frederico; Tagliari, Luciana Vilela; Mattioni, Mariana; Anzolin, Luisa; Oliveira, Maicon; Andrade, Juliana Mara; Falavigna, Maicon; Robinson, Caroline Cabral; Teixeira, Cassiano

doi:10.1007/s00134-018-5146-4

Cited by 15 publications

(8 citation statements)

References 5 publications

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“…Our experience shows that the most dependent patients are unable to access the outpatient clinic due to the risk of not being transported safely. ( 61 ) In our opinion, home visits could correct this problem, with results possibly similar to those in post-ICU outpatient clinics.…”

Section: Organization Of Post-intensive Care Outpatient Clinicsupporting

confidence: 56%

Post-intensive care outpatient clinic: is it feasible and effective? A literature review

Teixeira

Rosa

2018

Revista Brasileira De Terapia Intensiva

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The follow-up of patients who are discharged from intensive care units follows distinct flows in different parts of the world. Outpatient clinics or post-intensive care clinics represent one of the forms of follow-up, with more than 20 years of experience in some countries. Qualitative studies that followed up patients in these outpatient clinics suggest more encouraging results than quantitative studies, demonstrating improvements in intermediate outcomes, such as patient and family satisfaction. More important results, such as mortality and improvement in the quality of life of patients and their families, have not yet been demonstrated. In addition, which patients should be indicated for these outpatient clinics? How long should they be followed up? Can we expect an improvement of clinical outcomes in these followed-up patients? Are outpatient clinics cost-effective? These are only some of the questions that arise from this form of follow-up of the survivors of intensive care units. This article aims to review all aspects relating to the organization and performance of post-intensive care outpatient clinics and to provide an overview of studies that evaluated clinical outcomes related to this practice.

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Section: Organization Of Post-intensive Care Outpatient Clinicsupporting

confidence: 56%

Post-intensive care outpatient clinic: is it feasible and effective? A literature review

Teixeira

Rosa

2018

Revista Brasileira De Terapia Intensiva

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“…Our results showed that patients who were older and with a higher SAPS did not attend the NLC as often as younger patients and those with lower SAPS. Previous research found that about one‐fifth of patients, older, more fragile and with lower functional capacity, claimed inability to attend a follow‐up 36 . These patients may have a greater need and would benefit from a follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research found that about one-fifth of patients, older, more fragile and with lower functional capacity, claimed inability to attend a follow-up. 36 These patients may have a greater need and would benefit from a follow-up.…”

Section: Older Patients' Visitingmentioning

confidence: 99%

Factors and health‐related quality of life associated with participation in a post‐ICU follow‐up. A register study

Petersson¹,

Jakobsson

Westergren

et al. 2021

Acta Anaesthesiol Scand

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Background: Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time. Methods:Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004-2014, who participated in a 6-month follow-up programme offering visits to NLC at 2 and 6 months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2-, 6-and 12-month HRQoL by using SF-36 from the Swedish Intensive Care Registry.Results: Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P = .000), had lower Simplified Acute Physiology scores (P = .001) and higher SF-36 physical health domain scores at 2 months (P < .05) compared to those not visiting at all. Visitors at 2 months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6 months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12 months, whereas nonvisiting-patients' did this in four out of eight domains during the same time frame. Conclusion:Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations. | INTRODUC TI ONPost intensive care unit (ICU) follow-up contributes to increased knowledge about patients' needs and recovery after an ICU stay.Patients often report having remaining difficulties caused by the critical illness, treatment and care 1 and may suffer from new or worsening physical, cognitive or mental health problems, collectively named Post Intensive Care Syndrome (PICS). 2 Follow-up clinics may provide opportunities to help patients manage difficulties at different levels of care and at different time points. 3,4 A follow-up service and ICU diary have shown positive effects on posttraumatic stress disorder. 5,6 Patients visiting a nurse-led clinic (NLC) expressed, to a significantly greater extent, that they received advice and information, gained knowledge and re-evaluated memories and experiences from the ICU stay, compared to patients not attending the clinic. 7 However no convincing positive improvements were found regarding Health-Related Quality of Life (HRQoL) in 1 year follow-ups compared to standard care 8,9 or in a recovery programme also measuring sense of coherence and psychological health. 10 Also, systematic reviews have not been able to detect that follow-ups promote recovery. [11][12][13] How to cite this article: Glimelius Petersson C, Jakobsson L, Westergren A, Bergbom I. Factors and health-related quality of life associated wi...

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“…As disfunções orgânicas ocasionadas pela sepse bem como as sequelas físicas, cognitivas e de saúde mental podem exigir alterações no plano terapêutico destes pacientes com o objetivo de acelerar a reabilitação e prevenir sequelas adicionais, rehospitalizações ou até mesmo morte 19 . Reconciliação medicamentosa, otimização do manejo de doenças crônicas com risco de descompensação no período pós-alta hospitalar, vacinação, otimização dos processos de reabilitação e rastreamento/manejo de incapacidades físicas (ex: fraqueza muscular, redução da capacidade respiratória, lesões laringotraqueais, contraturas articulares, disfagia) e neuropsiquiátricas (ex: deficit cognitivo, ansiedade, depressão, TEPT) constituem o cerne do acompanhamento pós-alta hospitalar do paciente sobrevivente de sepse 62 . Entretanto, muitas vezes a dificuldade que estes encontram para o acesso a serviços de reabilitação configura um grande desafio para o seu adequado acompanhamento/tratamento pós-alta hospitalar, uma vez que o grau de sequelas pós-sepse pode constituir uma grande barreira para a adesão ao modelo clássico de acompanhamento ambulatorial no qual o paciente necessita se locomover até um serviço de saúde para se beneficiar de ações de reabilitação 63 .…”

Section: Prevenção E Manejo De Danos Em Longo-prazounclassified

Sepse após a alta da UTI: um problema de saúde pública

Teixeira¹,

Rosa²,

Friedman³

2021

CBR

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A sepse é uma disfunção orgânica aguda secundária à infecção e suas taxas de mortalidade hospitalar vêm reduzindo em muitos países nos últimos anos. Esta redução da mortalidade resulta em um maior número de pacientes que recebem alta hospitalar, porém frequentemente os sobreviventes experimentam novas incapacidades (físicas, cognitivas e psicológicas) e piora das condições crônicas de saúde em longo-prazo. Além disso, sua evolução pós-alta hospitalar cursa com elevado risco de morte e frequentes reinternações nos primeiros meses pós-hospitalização, bem como elevado uso de recursos de saúde. Esta revisão tem como objetivo descrever a morbimortalidade em longo prazo dos pacientes sobreviventes de sepse, seus efeitos sobre o sistema de saúde e as possíveis ações voltadas a minimizar as sequelas desta síndrome que acomete aproximadamente 1/3 dos pacientes admitidos em unidades de tratamento intensivo.

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More than the tip of the iceberg: association between disabilities and inability to attend a clinic-based post-ICU follow-up and how it may impact on health inequalities

Cited by 15 publications

References 5 publications

Post-intensive care outpatient clinic: is it feasible and effective? A literature review

Post-intensive care outpatient clinic: is it feasible and effective? A literature review

Factors and health‐related quality of life associated with participation in a post‐ICU follow‐up. A register study

Sepse após a alta da UTI: um problema de saúde pública

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