PLoS ONE (Jan 2019)

The association of intensive care with utilization and costs of outpatient healthcare services and quality of life.

  • Robert P Kosilek,
  • Sebastian E Baumeister,
  • Till Ittermann,
  • Matthias Gründling,
  • Frank M Brunkhorst,
  • Stephan B Felix,
  • Peter Abel,
  • Sigrun Friesecke,
  • Christian Apfelbacher,
  • Magdalena Brandl,
  • Konrad Schmidt,
  • Wolfgang Hoffmann,
  • Carsten O Schmidt,
  • Jean-François Chenot,
  • Henry Völzke,
  • Jochen S Gensichen

DOI
https://doi.org/10.1371/journal.pone.0222671
Journal volume & issue
Vol. 14, no. 9
p. e0222671

Abstract

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BackgroundLittle is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample.MethodsCross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding.ResultsICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment.ConclusionsOur findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.