Intensive Care Syndrome: Promoting Independence and Return to Employment - PowerPoint Presentation

Slide1

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)

Results and Findings

Slide2

What were we trying to achieve?

Improved Quality of Life in this groupEmpower patient to take control of their health and wellbeingIncrease Return to Employment by 20%Decrease GP visitation by 20%

Patient Satisfaction

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EQ-5D

(Quality of Life)

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How did we measure impact? H

istorical control group (2009-2010)Similar follow up dates to our population (One to two year post ICU discharge).

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Patient Empowerment

Generalised self-efficacy tool

The scale ranges from 10-40 (10 lowest possible self-efficacy and 40 being highest achievable score)Self-efficacy measurements were undertaken at baseline (start of clinic), week 5 of the clinic at six months and at 12

months.

Important Concept: We know that Self Efficacy is related to

QoL

.

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Increase Return to Employment by 20%

Again, Historical control group

Who got back to work at one year?

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Decrease GP visitation by 20%

How many patients regularly had contact with their GP at one yearWithin one cohort, it became apparent that we were increasing GP visitations! Empowerment

Did we improve the quality of visits?

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Patient Satisfaction

Undertaking qualitative interviewsPurposive sampling11 patients and caregivers at 6 months Thematic analysis utilised

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Statistical analysis

R (Version 3.3.0) for statistical analysis .  Continuous variables were expressed as medians and inter quartile ranges

and analysed using the Mann-Whitney U testCategorical variables were compared using chi squared

tests

 

All

tests were two sided and a

p

value of less than 0.05 was considered

significant

Multi- variable regression to adjust for differences between the groups (historical control vs. InS:PIRE cohort).

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48 patients took part in InS:PIRE over the one year learning period

2

patients ≥65 years and excluded from analysis

2

patients passed away in the follow up period

1

patient new diagnosis of cancer and did not want to continue with programme

3

patients did not complete EQ 5D at one year

2

of these patients had alcohol dependency

40

patients at one year analysed

87%

follow up rate

Patients

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Patient Characteristic

n=46

Gender (Male, %)

65.2%

Age (years, median, IQR)

51 (43-57)

ICU LOS (days, median, IQR)

15 (9-26)

APACHE II (median, IQR)

23 (18-27)

Charlson

Co-Morbidity Index (median, IQR)

1 (0-2)

Patients with Mental Health Problems Pre ICU (%)

45.7

SIMD Decile (median, IQR)

3 (1-4)

Hospital LOS (days, median, IQR)

47 (24-80)

Proportion Ventilated (%)

93.5

Proportion undergoing RRT (%)

34.8

Proportion undergoing CVS (%)

45.7

Employed Pre-ICU admission (%)

41.3

Retired Pre-ICU (%)

10.9

Unemployed Pre-ICU (%)

43.5

HUS Clinic Baseline (median, IQR)

0.364 (-0.041-0.689)

HUS One Year (median, IQR)

0.620 (0.320-0.726)

Patients

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Self Efficacy

Baseline median of SE 25.5 (IQR 19.75-30.25) to

28.5 (IQR 26-33.75) at five weeks (

p=0.003).

This was sustained at one year post InS:PIRE- median SE score of 29 (IQR 26-32).

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Quality of Life (QoL)

Compared the historical control group and the InS:PIRE cohort

Working age population only.

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Patient Characteristic

InS:PIRE cohort

(n=46)

Historical

Control

(n=53)

p value

Gender (male %)

65.2

58.5

0.63

Age (years, median, IQR)

51 (43-57)

47 (40-52)

0.16

ICU LOS (days, median, IQR)

15 (9-26)

3 (1-10)

<0.001

APACHE II (median, IQR)

23 (18-27)

14 (9-19)

<0.001

Charlson Co-Morbidity Index (median, IQR)

1 (0-2)

0 (0-2)

0.35

Patients with Mental Health Problems Pre ICU (%)

45.7

39.6

0.69

SIMD Decile (median, IQR)

3 (1-4)

2 (1-5)

0.31

Hospital LOS (days, median, IQR)

47 (24-80)

25 (11-50)

0.002

Proportion Ventilated (%)

93.5

79.2

0.12

Proportion undergoing RRT (%)

34.8

13.2

0.03

Proportion undergoing CVS (%)

45.7

17.0

0.005

Employed Pre-ICU admission (%)

41.3

47.2

0.07

HUS (Median, IQR)0.620 (0.320-0.726)0.516 (0.024-0.7100)0.26

InS:PIRE cohort vs. Historical control

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Multivariable regression

Factors that impact recoveryCharlson Co- morbidity

SIMDWork Pre-ICU

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Multivariable Analysis

For those who undertook the InS:PIRE programme there was a significant increase in their HUS after adjustment for social factors pre ICU (SIMD, Charlson Co-morbidity, in work pre-ICU) (0.16; 95% CI 0.011-0.305;

p=0.04)

Variable

Estimate

 

p value

Charlson

Score

-0.06 (-0.114

- -

0.008)

0.024

SIMD decile

0.03 (0.006-0.573

)

0.017

Working Pre ICU

0.18 (0.024-

-

0.057)

0.024

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Qualitative analysis

Support

Psychological Impact

Physical Impact

Future Direction

Patient volunteers

provided hope

,

optimism

and

peer

support.

Understanding of symptoms

and

coping

mechanisms

Increased confidence

and

independence

Longer time/balance of dependency

Staff (MDT) – cohesive approach

Family

benefit

Use of goals/personal goals

Importance of follow up

Created a community

Feeling normal, acknowledgement of illness

Importance of involving carers

 

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Support-Patient Volunteers

‘

It’s good to see how far somebody who has been so ill like yourself can improve and recover over a period of time.’

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Psychological Impact- Feeling Normal

‘..

it was so good to know that you were normal. I didn’t feel like an abnormal person anymore, I felt like everything I was feeling was a normal reaction.’

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Physical Impact- Goal Setting

‘I was nervous in case I didn’t achieve them and then coming back today to realise that I have actually overachieved a couple….it was a good thing because I would not have set goals for myself’.

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Return To Work

Pre ICU17 of the 40 patients employed pre ICU (42.5%)4 retired (10%)

19 unemployed/chronically unwell pre ICU(47.5%) Post InS:PIRE8 patients returned to employment or volunteering roles after ICU (71%) vs 64% in historical control group.

One patient voluntarily retired (2.5%)

Those who weren’t in work pre ICU, 3 (7.5%) in volunteering roles.

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Limitations

Single entreSmall sample- not poweredLearning project- patients at different stages of recovery trajectory

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Conclusion

InS:PIRE is a safe, appropriate, person centred programme which patients and caregivers feel is beneficialOver the five weeks of InS:PIRE, patients felt more in control of their health and wellbeing

Those patients who have undergone the InS:PIRE programme appear to have a significantly better QoL than those patients who have not.

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Thanks!

Health FoundationHealth and Social Care Alliance Citizens Advice Bureau (Maryhill and Possilpark

)Glasgow Council for the Voluntary Sector (GVCS)Carers Centre (NHS GG&C and Glasgow City Council)Quality Unit at the Scottish GovernmentAll the patients who took part

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.........

We enjoyed last Thursday, we miss coming up to see you all. Thanks for giving us our lives back

Liz x