Journal
THORAX
Volume -, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/thoraxjnl-2021-218428
Keywords
critical care; ARDS; pulmonary rehabilitation
Categories
Funding
- Health Foundation [173544]
- THIS.Institute (University of Cambridge) Fellowship [307748/PD-2019--02--16]
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This study evaluated the impact of a comprehensive healthcare and social care intervention for critical care survivors. The results showed significant improvements in health-related quality of life, self-efficacy, and symptoms of depression and anxiety among patients who received the intervention. Key facilitators for implementation include integration with inpatient care and organizational engagement.
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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