An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study

John Griffiths, Robert A Hatch, Judith Bishop, Kayleigh Morgan, Crispin Jenkinson, Brian H Cuthbertson, Stephen J Brett, John Griffiths, Robert A Hatch, Judith Bishop, Kayleigh Morgan, Crispin Jenkinson, Brian H Cuthbertson, Stephen J Brett

Abstract

Introduction: The socio-economic impact of critical illnesses on patients and their families in Europe has yet to be determined. The aim of this exploratory study was to estimate changes in family circumstances, social and economic stability, care requirements and access to health services for patients during their first 12 months after ICU discharge.

Methods: Multi-center questionnaire-based study of survivors of critical illness at 6 and 12 months after ICU discharge.

Results: Data for 293 consenting patients who spent greater than 48 hours in one of 22 UK ICUs were obtained at 6 and 12 months post-ICU discharge. There was little evidence of a change in accommodation or relationship status between pre-admission and 12 months following discharge from an ICU. A negative impact on family income was reported by 33% of all patients at 6 months and 28% at 12 months. There was nearly a 50% reduction in the number of patients who reported employment as their sole source of income at 12 months (19% to 11%) compared with pre-admission. One quarter of patients reported themselves in need of care assistance at 6 months and 22% at 12 months. The majority of care was provided by family members (80% and 78%, respectively), for half of whom there was a negative impact on employment. Amongst all patients receiving care, 26% reported requiring greater than 50 hours a week. Following discharge, 79% of patients reported attending their primary care physician and 44% had seen a community nurse. Mobility problems nearly doubled between pre-admission and 6 months (32% to 64%). Furthermore, 73% reported moderate or severe pain at 12 months and 44% remained significantly anxious or depressed.

Conclusions: Survivors of critical illness in the UK face a negative impact on employment and commonly have a care requirement after discharge from hospital. This has a corresponding negative impact on family income. The majority of the care required is provided by family members. This effect was apparent by 6 months and had not materially improved by 12 months. This exploratory study has identified the potential for a significant socio-economic burden following critical illness.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Sources of income prior to admission and at 6 and 12 months post-ICU discharge. Mixed income is where the patient has reporting having more than one source of income at any point in time.
Figure 3
Figure 3
Changes in financial income brackets. Income shift at 6 and 12 months compared with pre-admission expressed in terms of changes in income brackets (from question 10 derived from Reference 25).
Figure 4
Figure 4
Changes in employment for family carers. Changes in employment status amongst families with care requirements.
Figure 5
Figure 5
Services utilized at 12 months post-ICU discharge. A comparison of the services actually accessed by patients following ICU discharge and services patients feel they would have liked to have accessed following discharge from ICU. GP: general practitioner

References

    1. Cuthbertson BH, Scott J, Strachan M, Kilonzo M, Vale L. Quality of life before and after intensive care. Anaesthesia. 2005;60(4):332–339. doi: 10.1111/j.1365-2044.2004.04109.x.
    1. Wright JC, Plenderleith L, Ridley SA. Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia. 2003;58(7):637–642. doi: 10.1046/j.1365-2044.2003.03205.x.
    1. Broomhead LR, Brett SJ. Clinical review: intensive care follow-up - what has it told us? Crit Care. 2002;6(5):411–417. doi: 10.1186/cc1532.
    1. Griffiths J, Gager M, Alder N, Fawcett D, Waldmann C, Quinlan J. A self-report-based study of the incidence and associations of sexual dysfunction in survivors of intensive care treatment. Intensive Care Med. 2006;32(3):445–451. doi: 10.1007/s00134-005-0048-7.
    1. Griffiths J, Fortune G, Barber V, Young JD. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007;33(9):1506–1518. doi: 10.1007/s00134-007-0730-z.
    1. Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Ely EW. Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care. 2007;11:R27. doi: 10.1186/cc5707.
    1. Sukantarat K, Greer S, Brett S, Williamson R. Physical and psychological sequelae of critical illness. Br J Health Psychol. 2007;12(Pt 1):65–74.
    1. Sukantarat KT, Burgess PW, Williamson RC, Brett SJ. Prolonged cognitive dysfunction in survivors of critical illness. Anaesthesia. 2005;60(9):847–853. doi: 10.1111/j.1365-2044.2005.04148.x.
    1. Audit Commission. Critical to success. The place of efficient and effective critical care services within the acute hospital. London; 1999.
    1. Department of Health. Critical care outreach 2003: progress in developing services. 2003.
    1. Covinsky KE, Goldman L, Cook EF, Oye R, Desbiens N, Reding D, Fulkerson W, Connors AF, Lynn J, Phillips RS. The impact of serious illness on patients' families. SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. JAMA. 1994;272(23):1839–1844. doi: 10.1001/jama.1994.03520230049037.
    1. Swoboda SM, Lipsett PA. Impact of a prolonged surgical critical illness on patients' families. Am J Crit Care. 2002;11(5):459–466.
    1. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–693. doi: 10.1056/NEJMoa022450.
    1. Griffiths JA, Barber VS, Cuthbertson BH, Young JD. A national survey of intensive care follow-up clinics. Anaesthesia. 2006;61(10):950–955. doi: 10.1111/j.1365-2044.2006.04792.x.
    1. I-Canuk: Intensive Care After Care Network.
    1. Intensive Care Society. Levels of Critical Care for Adult Patients. 2009.
    1. EuroQol Group. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.
    1. The Health Institute. SF-36 Health Survey: Manual and Interpretation Guide. Boston; 1993.
    1. Badia X, Diaz-Prieto A, Gorriz MT, Herdman M, Torrado H, Farrero E, Cavanilles JM. Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med. 2001;27(12):1901–1907. doi: 10.1007/s00134-001-1137-x.
    1. Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care. 2010;14:R6. doi: 10.1186/cc8848.
    1. Dolan P, Gudex C, Kind P, Williams A. A social tariff for EuroQOL of life: results from a general UK general population survey. Centre for Health Economics Discussion Paper 138.
    1. Hayes JA, Black NA, Jenkinson C, Young JD, Rowan KM, Daly K, Ridley S. Outcome measures for adult critical care: a systematic review. Health Technol Assess. 2000;4(24):1–111.
    1. Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA. Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia. 1997;52:15–23. doi: 10.1111/j.1365-2044.1997.015-az014.x.
    1. Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health. 1999;53:46–50. doi: 10.1136/jech.53.1.46.
    1. ONS: How we took the 2011 Census.
    1. Heffernan C, Jenkinson C. Measuring outcomes for neurological disorders: a review of disease-specific health status instruments for three degenerative neurological conditions. Chronic Illn. 2005;1(2):131–142.
    1. Mockford C, Jenkinson C, Fitzpatrick R. A review: carers, MND and service provision. Amyotroph Lateral Scler. 2006;7(3):132–141. doi: 10.1080/14660820600601028.
    1. Harrison DA, Brady AR, Rowan K. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care. 2004;8(2):99–111. doi: 10.1186/cc2816.
    1. Van Pelt DC, Milbrandt EB, Qin L, Weissfeld LA, Rotondi AJ, Schulz R, Chelluri L, Angus DC, Pinsky MR. Informal caregiver burden among survivors of prolonged mechanical ventilation. Am J Respir Crit Care Med. 2007;175(2):167–173. doi: 10.1164/rccm.200604-493OC.
    1. Im K, Belle SH, Schulz R, Mendelsohn AB, Chelluri L. Prevalence and outcomes of caregiving after prolonged (≥48 hours) mechanical ventilation in the ICU. Chest. 2004;125(2):597–606. doi: 10.1378/chest.125.2.597.
    1. Daly BJ, Douglas SL, Kelley CG, O'Toole E, Montenegro H. Trial of a disease management program to reduce hospital readmissions of the chronically critically ill. Chest. 2005;128(2):507–517. doi: 10.1378/chest.128.2.507.
    1. Douglas SL, Daly BJ. Caregivers of long-term ventilator patients: physical and psychological outcomes. Chest. 2003;123(4):1073–1081. doi: 10.1378/chest.123.4.1073.
    1. Rossi Ferrario S, Zotti AM, Zaccaria S, Donner CF. Caregiver strain associated with tracheostomy in chronic respiratory failure. Chest. 2001;119(5):1498–1502. doi: 10.1378/chest.119.5.1498.
    1. (Paul Broadhead TBSA, private communication)
    1. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31(5):611–620. doi: 10.1007/s00134-005-2592-6.
    1. Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D. Changes in quality of life after intensive care: comparison with normal data. Anaesthesia. 1997;52(3):195–202. doi: 10.1111/j.1365-2044.1997.073-az0068.x.
    1. Chandola T, Jenkinson C. Social class differences in morbidity using the new UK National Statistics Socio-Economic Classification. Do class differences in employment relations explain class differences in health? Ann NY Acad Sci. 1999;896:313–315. doi: 10.1111/j.1749-6632.1999.tb08126.x.
    1. Chandola T, Jenkinson C. The new UK National Statistics Socio-Economic Classification (NS-SEC); investigating social class differences in self-reported health status. J Public Health Med. 2000;22(2):182–190. doi: 10.1093/pubmed/22.2.182.
    1. Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience. Am J Crit Care. 2011;20:12–22. doi: 10.4037/ajcc2011243.
    1. Adhikari NK, McAndrews MP, Tansey CM, Matte A, Pinto R, Cheung AM, Diaz-Granados N, Barr A, Herridge MS. Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest. 2009;135(3):678–687. doi: 10.1378/chest.08-0974.
    1. Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, Hull A, Breeman S, Norrie J, Jenkinson D, Hernandez R, Johnston M, Wilson E, Waldmann C, McDonald A, McPherson G, Ramsay CR, Vale L, Pflanz-Sinclair C, Wildsmith JA, Rose S, Williams B, Walsh T. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:b3723. doi: 10.1136/bmj.b3723.
    1. Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, Cameron JI, Tomlinson G, Mazzulli T, Walmsley SL, Rachlis AR, Mederski BD, Silverman M, Shainhouse Z, Ephtimios IE, Avendano M, Downey J, Styra R, Yamamura D, Gerson M, Stanbrook MB, Marras TK, Phillips EJ, Zamel N, Richardson SE, Slutsky AS, Herridge MS. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167(12):1312–1320. doi: 10.1001/archinte.167.12.1312.
    1. HMRC: Average exchange rates for the year to 31 March 2009.

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