Date Published: May 23, 2019
Publisher: Public Library of Science
Author(s): Ilse van Beusekom, Ferishta Bakhshi-Raiez, Nicolette F. de Keizer, Marike van der Schaaf, Fabian Termorshuizen, Dave A. Dongelmans, Shane Patman.
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.
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.
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.
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.
ICU survivors suffer long-term and severe complaints such as physical, mental, and cognitive impairments, limitations in daily and social activities, and problems affecting their work and employment, [1, 2] all leading to a reduced quality of life. The term ‘Post Intensive Care Syndrome’ (PICS) was introduced to describe the presence of one or more physical, cognitive or mental impairments after critical illness . Although the exact prevalence of PICS among ICU survivors is unknown, it is estimated that 25–50% of ICU survivors will suffer from some component of PICS after hospital discharge [4–6].
For this project, we combined data from the Dutch National Intensive Care Evaluation (NICE) registry  with data from the health insurance claims database of Vektis  and conducted a retrospective cohort study.
The final study population consisted of 56,267 ICU patients and an equal number of matched persons in the population-based control group. An overview of the data linkage and data matching process is given in Fig 1. Demographic information of the ICU patients and the control group is given in Table 1.
This study showed that ICU patients have more consultations with GPs during the year before and the year after hospital admission compared to a matched control group. Shortly before hospital admission and shortly after hospital discharge, the number of GP contacts is substantially increased. During the last four weeks before admission, ICU patients have 3.58 (CI 3.37; 3.80) times more GP consultations compared to the control group. During the first four weeks after discharge, ICU patients have 4.98 (CI 4.74; 5.23) times more GP consultations. One year after hospital discharge, ICU patients have 1.91 (CI 1.88; 1.93) times more GP consultations compared to the control group; this is still higher than the same period before hospital admission (RR 1.55 (CI 1.53; 1.57).
This study showed that ICU patients have more consultations with GPs during the year before and the year after hospital admission compared to a matched control group. Near the time of hospital admission and shortly after hospital discharge, the number of GP contacts substantially increases within the ICU population. We suggest that GPs should be informed about the problems ICU patients suffer after discharge, in order to provide the care they need. More research about how the care delivered by GPs can be integrated in ICU follow-up care is necessary, and is likely to might be beneficial for this large group of patients.