A pragmatic randomised, controlled trial of intensive care follow up programmes in improving longer-term outcomes from critical illness: the PRACTICAL study

Brian Cuthbertson, Janice Rattray, Marie Johnston, J Anthony Wildsmith, Edward Wilson, Rodolfo Hernandez, Craig Ramsay, Alastair M Hull, John Norrie, Marion Campbell, PRaCTICaL Study Group

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Abstract

Background: A number of intensive care (ICU) patients experience significant problems with physical, psychological, and social functioning for some time after discharge from ICU. These problems have implications not just for patients, but impose a continuing financial burden for the National Health Service. To support recovery, a number of hospitals across the UK have developed Intensive Care follow-up clinics. However, there is a lack of evidence base to support these, and this study aims to test the hypothesis that intensive care follow up programmes are effective and cost-effective at improving physical and psychological quality of life in the year after intensive care discharge. Methods/Design: This is a multi-centre, pragmatic, randomised controlled trial. Patients (n = 270) will be recruited prior to hospital discharge from three intensive care units in the UK, and randomised to one of two groups. The control group will receive standard in-hospital follow-up and the intervention group will participate in an ICU follow-up programme with clinic appointments 2–3 and 9 months after ICU discharge. The primary outcome measure is Health-related Quality of Life (HRQoL) 12 months after ICU discharge as measured by the Short Form-36. Secondary measures include: HRQoL at six months; Quality-adjusted life years using EQ-5D; posttraumatic psychopathology as measured by Davidson Trauma Scale; and anxiety and depression using the Hospital Anxiety and Depression Scale at both six and twelve months after ICU discharge. Contacts with health services in the twelve months after ICU discharge will be measured as part of the economic analysis. Discussion: The provision of intensive care follow-up clinics within the UK has developed in an ad hoc manner, is inconsistent in both the number of hospitals offering such a service or in the type of service offered. This study provides the opportunity to evaluate such services both in terms of patient benefit and cost-effectiveness. The results of this study therefore will inform clinical practice and policy with regard to the appropriate development of such services aimed at improving outcomes after intensive care.
Original languageEnglish
Article number116
Number of pages6
JournalBMC Health Services Research
Volume7
DOIs
Publication statusPublished - 23 Jul 2007

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Critical Care
Critical Illness
Randomized Controlled Trials
Quality of Life
Cost-Benefit Analysis
Anxiety
Depression
Psychology
Quality-Adjusted Life Years
National Health Programs
Psychopathology
Health Services
Intensive Care Units
Appointments and Schedules
Economics
Outcome Assessment (Health Care)
Costs and Cost Analysis
Control Groups
Wounds and Injuries

Keywords

  • quality-of-life
  • respiratory-distress-syndrome
  • posttraumatic-stress-disorder
  • ill patients
  • survivors
  • ICU

Cite this

A pragmatic randomised, controlled trial of intensive care follow up programmes in improving longer-term outcomes from critical illness : the PRACTICAL study. / Cuthbertson, Brian; Rattray, Janice; Johnston, Marie; Wildsmith, J Anthony; Wilson, Edward; Hernandez, Rodolfo; Ramsay, Craig; Hull, Alastair M; Norrie, John; Campbell, Marion; PRaCTICaL Study Group.

In: BMC Health Services Research, Vol. 7, 116, 23.07.2007.

Research output: Contribution to journalArticle

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abstract = "Background: A number of intensive care (ICU) patients experience significant problems with physical, psychological, and social functioning for some time after discharge from ICU. These problems have implications not just for patients, but impose a continuing financial burden for the National Health Service. To support recovery, a number of hospitals across the UK have developed Intensive Care follow-up clinics. However, there is a lack of evidence base to support these, and this study aims to test the hypothesis that intensive care follow up programmes are effective and cost-effective at improving physical and psychological quality of life in the year after intensive care discharge. Methods/Design: This is a multi-centre, pragmatic, randomised controlled trial. Patients (n = 270) will be recruited prior to hospital discharge from three intensive care units in the UK, and randomised to one of two groups. The control group will receive standard in-hospital follow-up and the intervention group will participate in an ICU follow-up programme with clinic appointments 2–3 and 9 months after ICU discharge. The primary outcome measure is Health-related Quality of Life (HRQoL) 12 months after ICU discharge as measured by the Short Form-36. Secondary measures include: HRQoL at six months; Quality-adjusted life years using EQ-5D; posttraumatic psychopathology as measured by Davidson Trauma Scale; and anxiety and depression using the Hospital Anxiety and Depression Scale at both six and twelve months after ICU discharge. Contacts with health services in the twelve months after ICU discharge will be measured as part of the economic analysis. Discussion: The provision of intensive care follow-up clinics within the UK has developed in an ad hoc manner, is inconsistent in both the number of hospitals offering such a service or in the type of service offered. This study provides the opportunity to evaluate such services both in terms of patient benefit and cost-effectiveness. The results of this study therefore will inform clinical practice and policy with regard to the appropriate development of such services aimed at improving outcomes after intensive care.",
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author = "Brian Cuthbertson and Janice Rattray and Marie Johnston and Wildsmith, {J Anthony} and Edward Wilson and Rodolfo Hernandez and Craig Ramsay and Hull, {Alastair M} and John Norrie and Marion Campbell and {PRaCTICaL Study Group}",
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AU - Cuthbertson, Brian

AU - Rattray, Janice

AU - Johnston, Marie

AU - Wildsmith, J Anthony

AU - Wilson, Edward

AU - Hernandez, Rodolfo

AU - Ramsay, Craig

AU - Hull, Alastair M

AU - Norrie, John

AU - Campbell, Marion

AU - PRaCTICaL Study Group

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AB - Background: A number of intensive care (ICU) patients experience significant problems with physical, psychological, and social functioning for some time after discharge from ICU. These problems have implications not just for patients, but impose a continuing financial burden for the National Health Service. To support recovery, a number of hospitals across the UK have developed Intensive Care follow-up clinics. However, there is a lack of evidence base to support these, and this study aims to test the hypothesis that intensive care follow up programmes are effective and cost-effective at improving physical and psychological quality of life in the year after intensive care discharge. Methods/Design: This is a multi-centre, pragmatic, randomised controlled trial. Patients (n = 270) will be recruited prior to hospital discharge from three intensive care units in the UK, and randomised to one of two groups. The control group will receive standard in-hospital follow-up and the intervention group will participate in an ICU follow-up programme with clinic appointments 2–3 and 9 months after ICU discharge. The primary outcome measure is Health-related Quality of Life (HRQoL) 12 months after ICU discharge as measured by the Short Form-36. Secondary measures include: HRQoL at six months; Quality-adjusted life years using EQ-5D; posttraumatic psychopathology as measured by Davidson Trauma Scale; and anxiety and depression using the Hospital Anxiety and Depression Scale at both six and twelve months after ICU discharge. Contacts with health services in the twelve months after ICU discharge will be measured as part of the economic analysis. Discussion: The provision of intensive care follow-up clinics within the UK has developed in an ad hoc manner, is inconsistent in both the number of hospitals offering such a service or in the type of service offered. This study provides the opportunity to evaluate such services both in terms of patient benefit and cost-effectiveness. The results of this study therefore will inform clinical practice and policy with regard to the appropriate development of such services aimed at improving outcomes after intensive care.

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