Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands.
Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Science, Nijmegen, the Netherlands.
Eur J Gen Pract. 2023 Dec;29(1):2213476. doi: 10.1080/13814788.2023.2213476.
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.
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.
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.
ICU survivors ( = 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.
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.
患者在入住重症监护病房（ICU）后会出现长期健康问题，被定义为 ICU 后综合征（PICS）。目前对于初级保健中的 PICS 知之甚少。
调查 ICU 幸存者与没有 ICU 入住史但具有相似合并症的患者相比，是否会遇到更多的新国际初级保健分类-2（ICPC-2）诊断和全科医生（GP）就诊。
这是一项在荷兰三个初级保健中心进行的前瞻性多中心队列研究。从 GP 的信息系统中提取了 2008 年至 2017 年期间入住 ICU 年龄≥16 岁的 ICU 幸存者的疾病发作次数和 GP 就诊次数。根据患者病史，为年龄、性别、随访时间和合并症组匹配了一个非 ICU 参考队列，每组 1:1。使用负二项回归分析比较了两组患者 ICU 入住前 1 年、0-3 个月、3-6 个月、6-12 个月、1-2 年和 2-5 年以及 ICU 入住前 1 年的就诊次数。
ICU 幸存者（n=199）在 ICU 入住前 1 年（平均 3.97 [95%置信区间（CI）：3.50-4.52]）至 2-5 年（3.65 [3.15-4.26]）期间遇到更多的新发疾病发作，而参考组为 2.36 [1.28-3.17]）。在 ICU 入住前 1 年（平均 19.61 [17.31-22.17]）至 2-5 年（18.53 [15.58-21.85]）期间，ICU 幸存者也有更多的 GP 就诊次数，而参考组为 10.02 [7.81-12.38]）。与非 ICU 患者相比，有 ICU 入住史的患者在特定的 ICPC-2 章节中并未出现就诊模式。
入住 ICU 的患者会遇到更多的初级保健新发疾病发作和 GP 就诊。由于患者首先向 GP 报告其症状，因此识别这些与重症相关的症状的责任在于 GP。
