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Primary care intervention does not improve sepsis survivors' mental health QOL
A primary care-focused intervention program appeared to have no effect on the mental well-being of sepsis survivors, according to a recently published investigation.
“Although more patients survive sepsis and are increasingly discharged from the hospital, they often experience functional disability, cognitive impairment and psychiatric morbidity,” Konrad Schmidt, MD, medical staff and research assistant at the Institute of General Practice and Family Medicine at Jena University Hospital, Germany, and colleagues wrote. “[This can result] in diminished health-related quality of life (QOL), increased health care costs and burden on patients and their families.”
Although many of these patients will have comorbidities managed in primary care, no interventions for managing sepsis sequelae have been developed for this setting, the researchers wrote.
To investigate one potential approach, the investigators enrolled 291 German sepsis survivors into an unmasked, multicenter, randomized clinical trial comparing standard sepsis aftercare, which includes periodic contacts, referrals to specialists and prescriptions for other conditions, to a team-based intervention involving patient and PCP-training, case management by trained nurses and clinical decision support and consultation. The researchers primarily examined changes in mental health-related QOL 6 months after discharge from an ICU, as assessed by the Mental Component Summary (MCS) score of the 36-Item Short-Form Health Survey (SF-36). In addition, they evaluated patients’ overall survival, mental health outcomes, functional outcomes and other scores included in the SF-36 at 6 and 12 months.
The mean age of the participants was 61.6 years, and the median ICU length of stay was 26 days. Two-thirds of these were men, 84.4% of participants required mechanical ventilation during their ICU stay, and 59.2% reported neuropathic symptoms. Baseline characteristics between the groups were similar. Overall mortality was 13.7% at 6 months and 18.2% at 12 months.
After 6 months, the researchers observed no significant differences in mean MCS score changes between the groups (mean treatment effect, 2.15; 95% CI, –1.79 to 6.09). Additional analyses of physical health-related QOL and mental health outcomes revealed no differences at 6 and 12 months. The only secondary outcomes for which the intervention showed benefit were physical function scores, physical disability scores and activities of daily living (ADL) impairment frequency at 6 months, while sleep impairment frequency was reduced at 12 months.
Although the findings did not suggest any improvements for sepsis survivors’ mental health, Schmidt and colleagues wrote that the secondary findings imply that similar interventions could be beneficial for recuperating patients’ physical function and ability to perform ADL. However, additional research is needed to confirm these findings. – by Dave Muoio
Disclosure: Schmidt reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.