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Am J Med. 2019 Sep 12. pii: S0002-9343(19)30756-9. doi: 10.1016/j.amjmed.2019.08.033. [Epub ahead of print]

Long-term courses of sepsis survivors: effects of a primary care management intervention.

Author information

1
Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany; Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany; Center of Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany. Electronic address: Konrad.Schmidt@charite.de.
2
Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany; Center of Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
3
Dpt. of Family Medicine, University of Washington School of Medicine, 4225 Roosevelt Way NE, Suite 308, Seattle, WA 98105-6099, USA.
4
Center of Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747 Jena, Germany.
5
Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany.
6
Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
7
Center of Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; Dpt. of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
8
Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany; Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystrasse 3, 07740 Jena, Germany.
9
Group Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Group Health Cooperative 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA.
10
Institute of Family Medicine and Health Services Research, Heidelberg University Hospital, Marsilius-Arkaden, Turm West, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
11
Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany; Center of Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Pettenkoferstraße 10, 80336 München, Germany.

Abstract

BACKGROUND:

Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit (ICU). The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.

METHODS:

This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German ICUs. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.

RESULTS:

186 [63.9%, 98 intervention, 88 control] of 291 patients completed the 24-month follow-up showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (PTSS-10) (diff. PTSS-10 to baseline, mean (SD) 3.7(11.8) control vs. -0.7(12.1) intervention; p=0.016). There were no significant differences in all other outcomes between the intervention and control groups.

CONCLUSIONS:

12 months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.

KEYWORDS:

Aftercare; Primary Health Care; Rehabilitation; Sepsis; Stress Disorders, Post-Traumatic

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