Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

Abstract

Background

Patients experience long-lasting health problems defined as post-intensive care syndrome (PICS) after Intensive Care Unit (ICU) admission. Little is known about PICS in primary care.

Objectives

To investigate whether ICU survivors encounter more new International Classification of Primary Care-2 (ICPC-2) diagnoses and general practitioner (GP) contact compared to patients with similar comorbidity without ICU admission.

Methods

Prospective multicentre cohort study in three Dutch general practices. Numbers of disease-episodes and GP contacts of ICU survivors ≥ 16 years admitted between 2008 and 2017 were extracted from GPs’ information systems. A non-ICU reference cohort was matched 1:1 for age, sex, follow-up period and comorbidity groups from patients’ medical history. Negative binominal regression analysis was used to compare both cohorts 0–3, 3–6, 6–12 months, 1–2 and 2–5 years after ICU admission and 1 year prior to admission.

Results

ICU survivors (n = 199) encountered more new disease-episodes 1 year before (mean 3.97 (95% confidence interval [CI] 3.50–4.52]]; reference 2.36 [1.28–3.17]) to 2–5 years after ICU admission (3.65 [3.15–4.26]; reference 2.86 [2.52–3.22]). ICU survivors also had more GP contacts 1 year before (mean 19.61 [17.31–22.17]; reference 10.02 [7.81–12.38]) to 2–5 years after ICU admission (18.53 [15.58–21.85]; reference 12.03 [10.33–13.91]). Patients with prior ICU admission did not encounter patterns in specific ICPC-2 chapters compared to non-ICU patients.

Conclusion

Patients admitted to the ICU encounter more new primary care disease-episodes and GP contacts. As patients present their symptoms to their GP first, it is therefore up to the GP to recognise these critical illness-related symptoms.