Bibliographic Details
| Title: |
Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study |
| Authors: |
Bathmapriya Balakrishnan, Lucas Hamrick, Ariful Alam, Jesse Thompson |
| Source: |
JMIR Formative Research, Vol 7, p e43759 (2023) |
| Publisher Information: |
JMIR Publications, 2023. |
| Publication Year: |
2023 |
| Collection: |
LCC:Medicine |
| Subject Terms: |
Medicine |
| More Details: |
BackgroundPost-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. ObjectiveWe explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. MethodsThis randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. ResultsBoth SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants’ mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. ConclusionsThis exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2561-326X |
| Relation: |
https://formative.jmir.org/2023/1/e43759; https://doaj.org/toc/2561-326X |
| DOI: |
10.2196/43759 |
| Access URL: |
https://doaj.org/article/c0bf0cb5dec04150b2fc7a7d05aeb42a |
| Accession Number: |
edsdoj.0bf0cb5dec04150b2fc7a7d05aeb42a |
| Database: |
Directory of Open Access Journals |
