Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic's first wave.
Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic's first wave.
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DOI：
10.1136/bmjopen-2020-048392
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发表时间：
2021-05-11
期刊：
影响因子：
2.9
通讯作者：
Bloor K
中科院分区：
文献类型：
--
作者：
Castro-Avila AC;Jefferson L;Dale V;Bloor K
确定重症监护病房（ICU）出院患者的随访服务计划，并探讨ICU工作人员和全科医生（gp）对这些患者未来需求和护理协调的看法。这是一项连续的混合方法研究，使用在线调查和半结构化访谈。对访谈数据进行归纳编码和主题分析。对调查数据进行描述性分析。全科医生手术和急性国民健康服务信托在英国。全科医生和临床医生领导护理从ICU出院的病人。ICU出院后通常的随访做法，大流行期间随访的变化，以及全科医生对ICU出院患者随访和支持需求的认识。我们获得了170份调查回复，并进行了23次访谈。60%以上的全科医生不知道当地医院通常提供的后续服务，也不知道这些服务在大流行期间是否在运作。80%的icu报告了某种形式的后续服务，其中25%在大流行高峰期间暂停提供服务，一半以上修改了提供的服务（通常是远程提供服务）。与提供后续行动障碍有关的共同主题是资金复杂性、职权范围和专门知识以及ICU与社区服务之间的沟通。出院文件被描述为糟糕和缺乏关键信息。这两个群体都提到了在社区获得服务的困难，以及谁负责转诊和后续工作的不明确。大流行突出了长期存在的护理连续性问题和icu后随访护理的复杂资金流。由于COVID-19而入院的大量ICU患者凸显了改善随访服务和专家与全科医生之间沟通的必要性，不仅针对COVID-19患者，而且针对所有从ICU出院的患者。
To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination. This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed. GP surgeries and acute National Health Service Trusts in the UK. GPs and clinicians leading care for patients discharged from ICU. Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU. We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up. The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.
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