Article
The association of intensive care with utilization and costs of outpatient healthcare services and quality of life: Results from two independent population-based cohorts
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Published: | September 11, 2019 |
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Background: Recent studies have indicated that intensive care unit (ICU) treatment is associated with long-term physical and neuropsychiatric impairments. Little is known about outpatient health services use following intensive care.
Objective: To examine the association of intensive care with outpatient health services utilization, costs and health-related quality of life in a population-based sample.
Methods: Cross-sectional analysis of data from a population-based study in northeastern Germany. Data on sociodemographic factors, medical history including ICU treatment and outpatient medical consultations, costs and quality of life (EQ-5D-3L) were obtained from 6,686 participants of the Study of Health in Pomerania (SHIP), which consist of two independent cohorts. Outpatient consultations were examined using prevalence ratios (PR) from Poisson regression. Number and costs of consultations were estimated using negative binomial and generalized linear models, expressed as percent change (PC). The EQ-5D index value was modeled using a fractional response model. 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.
Discussion: ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
Take home message for practical use: Post-ICU follow-up is a multi-disciplinary process.