Medication Management to Ameliorate Post–Intensive Care Syndrome

Stollings, Joanna L.; Bloom, Sarah; Huggins, Elizabeth; Grayson, Scottie L.; Jackson, James C.; Sevin, Carla M.

doi:10.4037/aacnacc2016931

Cited by 10 publications

(5 citation statements)

References 33 publications

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“…Our data suggest that ARF survivors have high numbers of medication needs and more than half have at least one unmet medication need. This evidence is consistent with other observations about polypharmacy in this population [31,32]. Notably, our study's secondary outcomes, at 3-month and 6-month follow-up, were consistent with prior cohorts noting high rates of psychological and cognitive disability after discharge [48,49].…”

Section: Discussionsupporting

confidence: 92%

“…Retrospective cohorts based on claims data have suggested that failures to follow through may be associated with early readmissions [25][26][27]. Similar to post-discharge management of heart failure [28], medications represent a particularly important target in the post-discharge care of patients who have survived an ICU admission [29][30][31][32]. Limited prospective data exist to clarify the relationships among support and care early after hospital discharge and subsequent clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

et al. 2022

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Introduction Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery. Methods and analysis In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors. Results We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02–0.99). Discussion Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

et al. 2022

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“…Medication reconciliation at the time of hospital discharge is particularly important for sepsis patients, who are likely to have had multiple medication adjustments during their hospitalization 45 . Chronic medications are frequently held and forgotten, while medications to treat acute symptoms may be continued inadverently 46–48 .…”

Section: Pharmacologic Strategiesmentioning

confidence: 99%

Improving Long-Term Outcomes After Sepsis

Prescott

Costa

2018

Critical Care Clinics

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Although acute survival from sepsis has improved in recent years, a large fraction of sepsis survivors experience poor long-term outcomes. In particular, sepsis survivors have high rates of weakness, cognitive impairment, hospital readmission, and late death. To improve long-term outcomes, in-hospital care should focus on early, effective treatment of sepsis; minimization of delirium, distress, and immobility; and preparing patients for hospital discharge. In the posthospital setting, medical care should focus on addressing new disability and preventing medical deterioration, providing a sustained period out of the hospital to allow for recovery.

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“…The optimal ICU-RC and COVID-RC structures and processes to achieve best PICS and PASC outcomes are still unknown. Reports have highlighted the role of specific providers (e.g., pharmacist [20]), staffing rationales [21], and services (e.g., medication reconciliation [22]) within ICU-RCs. At present, ICU-RCs and COVID-RCs have been developed iteratively with local clinicians and patients tailoring RC structure and processes to regional context and constraint (23, 24), leading to heterogeneous clinic models and measures (14).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

Danesh

Boehm

Eaton

et al. 2022

Critical Care Explorations

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OBJECTIVES: The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States. DESIGN: Cross-sectional survey. SETTING: Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated. PATIENTS: None. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%). CONCLUSIONS: Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

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Medication Management to Ameliorate Post–Intensive Care Syndrome

Cited by 10 publications

References 33 publications

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Improving Long-Term Outcomes After Sepsis

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems

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