Primary care based sepsis aftercare improves musculoskeletal function

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
3D.5

The problem

Having survived a sepsis or a septic shock, many patients suffer over years from a considerable functional deficit, which requires substantial aftercare needs following hospital discharge. Most of this care is provided in primary care settings. Especially musculoskeletal function is of high relevance for daily life. Our study's aim was to evaluate the effectiveness of a multifaceted, primary care-based intervention to reduce sepsis sequelae.

The approach

The Smooth-study is a randomized, multicenter controlled trial [ISRCTN: 61744782]. We recruited eligible patients surviving severe sepsis [A 41] or septic shock [R65.1/0]. Enrolled subjects were randomized to usual care or an intervention which comprised: 1) discharge management (structured information between inpatient and outpatient care); 2) training of Family Physicians (FPs) and patients on recognition of, and evidence-based care for, sepsis sequelae; and 3) systematic telephone monitoring of symptoms and activity with feedback for the FP by a case manager. Our primary outcome was the health-related quality of life (HrQoL) as assessed with the Short form (36) Health Survey (SF-36) at 6 months after intensive care unit (ICU) discharge. Secondary outcomes included besides others musculoskeletal function measured with the short musculoskeletal function assessment (XSMFA) at 6 and 12 months post-ICU.

Findings

We recruited 290 patients for the trial from 20 ICUs. 220 (75.9%) completed 6 month and 204 (70.3%) 12 month follow-up. At baseline there were no significant differences between randomization groups. At 6 month, we found a non-significant improvement in the SF-36 in the intervention group compared to the control group. The intervention group had significant improvement in musculoskeletal function.

Consequences

To our knowledge, this is the first large scale, primary care-based interventional trial targeting reduction in post-sepsis sequelae. The intervention improved musculoskeletal function which is of high relevance for all daily life activities. Our findings may be attributable to improved FP awareness and increased patient activation facilitated by case manager monitoring and support.

Credits

  • Konrad Schmidt, Center of Sepsis Control and Care
  • Susanne Worrack, Center of Sepsis Control and Care
  • Sabine Beck, University of Zuerich, Dpt. of Psychology, Zuerich, Switzerland
  • Frank Brunkhorst, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  • Dimitry Davydow, Charité University Hospital Berlin, Dept. of general practice and family medicine, Berlin, Germany
  • Ulrike Ehlert, Group Health Research Institute, Group Health Cooperative, Seattle, USA
  • Christoph Engel, Jena University Hospital, Dpt. of Anaesthesiology and Intensive Care Medicine, Jena, Germany
  • Christoph Heintze, University of Zuerich, Dpt. of Psychology, Zuerich, Switzerland
  • Juliane Mehlhorn, Center of Sepsis Control and Care
  • Christine Pausch, Jena University Hospital, Dpt. of Anaesthesiology and Intensive Care Medicine, Jena, Germany
  • Konrad Reinhart, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  • Michael von Korff
  • Michel Wensing, Dpt. of Psychiatry and Behavioral Sciences, Seattle, USA
  • Jochen Gensichen, Center of Sepsis Control and Care