Effect of a Primary Care Management Intervention on Mental Health–Related Quality of Life Among Survivors of Sepsis: A Randomized Clinical Trial

IMPORTANCE: Survivors of sepsis face long-term sequelae that diminish health-related quality of life and result in increased care needs in the primary care setting, such as medication, physiotherapy, or mental health care. OBJECTIVE: To examine if a primary care–based intervention improves mental he...

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Published in:JAMA : the journal of the American Medical Association 2016-06, Vol.315 (24), p.2703-2711
Main Authors: Schmidt, Konrad, Worrack, Susanne, Von Korff, Michael, Davydow, Dimitry, Brunkhorst, Frank, Ehlert, Ulrike, Pausch, Christine, Mehlhorn, Juliane, Schneider, Nico, Scherag, André, Freytag, Antje, Reinhart, Konrad, Wensing, Michel, Gensichen, Jochen
Format: Article
Language:English
Subjects:
Adult
Aged
Case Management
Decision Support Systems, Clinical
Female
Humans
Intensive Care Units
Male
Mental Health
Middle Aged
Patient Discharge
Physicians, Primary Care
Primary care
Primary Health Care - methods
Quality of Life
Referral and Consultation
Sepsis
Sepsis - psychology
Sepsis - rehabilitation
Survivor
Survivors
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Summary:IMPORTANCE: Survivors of sepsis face long-term sequelae that diminish health-related quality of life and result in increased care needs in the primary care setting, such as medication, physiotherapy, or mental health care. OBJECTIVE: To examine if a primary care–based intervention improves mental health–related quality of life. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial conducted between February 2011 and December 2014, enrolling 291 patients 18 years or older who survived sepsis (including septic shock), recruited from 9 intensive care units (ICUs) across Germany. INTERVENTIONS: Participants were randomized to usual care (n = 143) or to a 12-month intervention (n = 148). Usual care was provided by their primary care physician (PCP) and included periodic contacts, referrals to specialists, and prescription of medication, other treatment, or both. The intervention additionally included PCP and patient training, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. MAIN OUTCOMES AND MEASURES: The primary outcome was change in mental health–related quality of life between ICU discharge and 6 months after ICU discharge using the Mental Component Summary (MCS) of the 36-Item Short-Form Health Survey (SF-36 [range, 0-100; higher ratings indicate lower impairment; minimal clinically important difference, 5 score points]). RESULTS: The mean age of the 291 patients was 61.6 years (SD, 14.4); 66.2% (n = 192) were men, and 84.4% (n = 244) required mechanical ventilation during their ICU stay (median duration of ventilation, 12 days [range, 0-134]). At 6 and 12 months after ICU discharge, 75.3% (n = 219 [112 intervention, 107 control]) and 69.4% (n = 202 [107 intervention, 95 control]), respectively, completed follow-up. Overall mortality was 13.7% at 6 months (40 deaths [21 intervention, 19 control]) and 18.2% at 12 months (53 deaths [27 intervention, 26 control]). Among patients in the intervention group, 104 (70.3%) received the intervention at high levels of integrity. There was no significant difference in change of mean MCS scores (intervention group mean at baseline, 49.1; at 6 months, 52.9; change, 3.79 score points [95% CI, 1.05 to 6.54] vs control group mean at baseline, 49.3; at 6 months, 51.0; change, 1.64 score points [95% CI, −1.22 to 4.51]; mean treatment effect, 2.15 [95% CI, −1.79 to 6.09]; P = .28). CONCLUSIONS AND RELEVANCE: Among survivors of sepsis and septic shock, the use o
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2016.7207