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Long-Term Courses of Sepsis Survivors: Effects of a Primary Care Management Intervention

  • Konrad FR Schmidt
    Correspondence
    Requests for reprints should be addressed to Konrad FR Schmidt, MD, Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany

    Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany

    Center of Sepsis Control and Care, Jena University Hospital, Germany
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  • Daniel Schwarzkopf
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany

    Center of Sepsis Control and Care, Jena University Hospital, Germany
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  • Laura-Mae Baldwin
    Affiliations
    Department of Family Medicine, University of Washington School of Medicine, Seattle
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  • Frank M Brunkhorst
    Affiliations
    Center of Clinical Studies, Jena University Hospital, Germany
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  • Antje Freytag
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany
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  • Christoph Heintze
    Affiliations
    Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany
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  • Konrad Reinhart
    Affiliations
    Center of Sepsis Control and Care, Jena University Hospital, Germany

    Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
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  • Nico Schneider
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany

    Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany
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  • Michael von Korff
    Affiliations
    Kaiser Permanente Washington Health Research Institute, Seattle
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  • Susanne Worrack
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany

    Center of Sepsis Control and Care, Jena University Hospital, Germany
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  • Michel Wensing
    Affiliations
    Institute of Family Medicine and Health Services Research, Heidelberg University Hospital, Germany
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  • Jochen Gensichen
    Affiliations
    Institute of General Practice and Family Medicine, Jena University Hospital, Germany

    Center of Sepsis Control and Care, Jena University Hospital, Germany

    Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
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  • for the SMOOTH Study Group
    Author Footnotes
    1 Baenfer M, Berhold C, Bindara-Klippel A, Corea M, Davydov D, Eckholdt L, Eissler F, Engel Ch, Fleischmann-Struzek C, Freitag A, Gehrke-Beck S, Geist A, Gerlach H, Goldmann A, Graf J, Hamzei F, Hartmann M, Hartog Ch, Heintze Ch, Huelle K, Jakobi U, Kerth S, Keh D, Klefisch F, Kuehnemund R, Kuhnsch H, Lehmann Th, Lehmke J, Lehmkuhl P, Meier-Hellmann A, Muehlberg J, Mueller F, Oehmichen F, Ollenschlaeger G, Oppert M, Pohl M, Rademacher S, Reil L, Sablotzki A, Schelle M, Schelling G, Scherag A, Schreiber T,Spies C, Thiel P,Tiedemann G, Toepfer L,Toussaint S.
  • Author Footnotes
    1 Baenfer M, Berhold C, Bindara-Klippel A, Corea M, Davydov D, Eckholdt L, Eissler F, Engel Ch, Fleischmann-Struzek C, Freitag A, Gehrke-Beck S, Geist A, Gerlach H, Goldmann A, Graf J, Hamzei F, Hartmann M, Hartog Ch, Heintze Ch, Huelle K, Jakobi U, Kerth S, Keh D, Klefisch F, Kuehnemund R, Kuhnsch H, Lehmann Th, Lehmke J, Lehmkuhl P, Meier-Hellmann A, Muehlberg J, Mueller F, Oehmichen F, Ollenschlaeger G, Oppert M, Pohl M, Rademacher S, Reil L, Sablotzki A, Schelle M, Schelling G, Scherag A, Schreiber T,Spies C, Thiel P,Tiedemann G, Toepfer L,Toussaint S.
Published:September 13, 2019DOI:https://doi.org/10.1016/j.amjmed.2019.08.033

      Abstract

      Background

      Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.

      Methods

      This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group.
      At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.

      Results

      One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups.

      Conclusions

      Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
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