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

Abstract

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.

General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

“…Thus, a Dutch retrospective cohort study found an increased consultation rate in primary care following ICU discharge. 25 Considering that there were more than two million intensive care treatment cases just in Germany in 2017 26 and an assumed increase driven by the COVID-19 pandemic, 27 GPs need to know how to provide best postintensive care to these patients, as it…”

“…Thus, a Dutch retrospective cohort study found an increased consultation rate in primary care following ICU discharge. 25 Considering that there were more than two million intensive care treatment cases just in Germany in 2017 26 and an assumed increase driven by the COVID-19 pandemic, 27 GPs need to know how to provide best postintensive care to these patients, as it has been already called for by others. 28 The concept of the PICS is quite recent, but GPs’ intensive care experiences may date back to medical studies or early hospital rotations.…”

COVID-19 and pulmonary rehabilitation: preparing for phase three

“…Experiences with post-ICU follow-up clinics are reported [12], but insufficient evidence is available to determine whether ICU follow-up services are effective in identifying and addressing the unmet health needs of ICU survivors [13]. Since these patients do consult their general physician more frequently [14], it is essential to raise the awareness for PICS so that patients' ICU experiences are not merely a black box for their primary care physicians [15].…”

A Call for the World Health Organization to Create International Classification of Disease Diagnostic Codes for Post‐Intensive Care Syndrome in the Age of COVID‐19

“…Primary care providers should be able to screen for sequelae of PICS, PICS‐P, or PICS‐F and diagnose it if ICD‐10 codes exist, or be willing to refer patients to a psychiatric provider who could make the diagnosis. One recent study found ICU survivors who exhibit symptoms of PICS have more visits with primary care providers than patients with similar characteristics in the general population (van Beusekom et al, 2019).…”