Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study
Giora Netzer,
Anthony Bastin,
Tara Quasim,
Theodore Iwashyna,
Joanne McPeake,
Ramona O Hopkins,
Andrew Slack,
James Jackson,
Dorothy Wade,
Joel Meyer,
Ashley Montgomery-Yates,
Judith McCartney,
Leanne Boehm,
Elizabeth Hibbert,
Katrina Hauschildt,
Rita Bakhru,
Brad Butcher,
Tammy Eaton,
Wendy Harris,
Aluko Hope,
Annie Johnson,
Janet Kloos,
Karen Korzick,
Mary Still,
Mark E Mikkelsen,
Kimberley Haines,
Carla Sevin
Affiliations
Giora Netzer
Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland, USA
Anthony Bastin
Department of Peri-operative Medicine, Barts Health NHS Trust, London, UK
Tara Quasim
Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK
Theodore Iwashyna
Department of Internal Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan, USA
Joanne McPeake
Critical Care, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
Ramona O Hopkins
Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
Andrew Slack
Department of Critical Care, Guy`s and St Thomas` Hospitals NHS Trust, London, UK
James Jackson
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA
Dorothy Wade
Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
Joel Meyer
Department of Critical Care, Guy`s and St Thomas` NHS Foundation Trust, London, UK
Ashley Montgomery-Yates
University of Kentucky, Lexington, Kentucky, USA
Judith McCartney
Critical Care, NHS Greater Glasgow and Clyde, Glasgow, UK
Leanne Boehm
School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
Elizabeth Hibbert
Department of Physiotherapy, Western Health Foundation, Sunshine, Victoria, Australia
Katrina Hauschildt
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
Rita Bakhru
Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Brad Butcher
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Tammy Eaton
VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, Michigan, US
Wendy Harris
Intensive Care Unit, University College London, London, UK
Aluko Hope
Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Science University (OHSU), Portland, Oregon, USA
Annie Johnson
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
Janet Kloos
Department of Acute and Critical Care Nursing, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
Karen Korzick
Department of Pulmonary and Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
Mary Still
Critical Care, Emory University Hospital, Atlanta, Georgia, USA
Mark E Mikkelsen
Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Kimberley Haines
Department of Physiotherapy, Sunshine Hospital, Melbourne, Victoria, Australia
Carla Sevin
Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Objectives Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness.Design In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections.Setting 14 hospital sites in the USA, UK and Australia.Participants Patients and caregivers, who had been admitted to critical care from three continents.Results 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems.Conclusions Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one’s social network, economic security and access to healthcare is required following discharge from critical care.
