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The association of intensive care with utilization and costs of outpatient healthcare services and quality of life


Autoři: Robert P. Kosilek aff001;  Sebastian E. Baumeister aff002;  Till Ittermann aff004;  Matthias Gründling aff005;  Frank M. Brunkhorst aff006;  Stephan B. Felix aff007;  Peter Abel aff007;  Sigrun Friesecke aff007;  Christian Apfelbacher aff009;  Magdalena Brandl aff009;  Konrad Schmidt aff011;  Wolfgang Hoffmann aff004;  Carsten O. Schmidt aff004;  Jean-François Chenot aff004;  Henry Völzke aff004;  Jochen S. Gensichen aff001
Působiště autorů: Institute of General Practice and Family Medicine, LMU München, Munich, Germany aff001;  Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany aff002;  Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany aff003;  Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany aff004;  Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany aff005;  Integrated Research and Treatment Center Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany aff006;  Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany aff007;  DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany aff008;  Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany aff009;  Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore aff010;  Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany aff011;  Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany aff012;  German Center for Diabetes Research, Site Greifswald, Greifswald, Germany aff013
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222671

Souhrn

Background

Little is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample.

Methods

Cross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding.

Results

ICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment.

Conclusions

Our findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.

Klíčová slova:

Medicine and health sciences – Health care – Patients – Outpatients – Quality of life – Health care facilities – Hospitals – Intensive care units – Health care providers – Medical doctors – Physicians – General practitioners – Pharmaceutics – Drug therapy – Surgical and invasive medical procedures – Musculoskeletal system procedures – Orthopedic surgery – Public and occupational health – Socioeconomic aspects of health – Mental health and psychiatry – People and places – Population groupings – Professions – Medical personnel


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