TY - JOUR
T1 - Modification of social determinants of health by critical illness and consequences of that modification for recovery
T2 - an international qualitative study
AU - McPeake, Joanne
AU - Boehm, Leanne
AU - Hibbert, Elizabeth
AU - Hauschildt, Katrina
AU - Bakhru, Rita
AU - Bastin, Anthony
AU - Butcher, Brad
AU - Eaton, Tammy
AU - Harris, Wendy
AU - Hope, Aluko
AU - Jackson, James
AU - Johnson, Annie
AU - Kloos, Janet
AU - Korzick, Karen
AU - McCartney, Judith
AU - Meyer, Joel
AU - Montgomery-Yates, Ashley
AU - Quasim, Tara
AU - Slack, Andrew
AU - Wade, Dorothy
AU - Still, Mary
AU - Netzer, Giora
AU - Hopkins, Ramona O.
AU - Mikkelsen, Mark E.
AU - Iwashyna, Theodore
AU - Haines, Kimberley
AU - Sevin, Carla
N1 - Funding Information:
Efforts to address these resulting financial hardships through direct payments to patients and caregivers have shown promise; the Medicaid Cash and Counseling Programme found improved patient and caregiver well-being alongside improved health outcomes. Similarly, the US Department of Veteran Affairs’ Program of Comprehensive Assistance to Family Caregivers suggests financial support provides crucial assistance in varied ways, depending on specific needs. In the UK, efforts to include social welfare consultation as part of critical illness recovery programmes have also shown promise. These issues may become more prominent as moves to telehealth and remote monitoring require patients to bring more of their own technology to fully access services, potentially exacerbating inequities.
Funding Information:
KH, JMcP, LB, CS and TQ received funding from SCCM to undertake this work (no award number). LB is funded by NIH/NHLBI (K12 HL137943) so as is TI (K12 HL138039). JMcP is funded by a THIS.Institute (University of Cambridge) Fellowship (PD-2019-02-16/307748-01).
Publisher Copyright:
©
PY - 2022/9/27
Y1 - 2022/9/27
N2 - Objectives Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness. Design In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections. Setting 14 hospital sites in the USA, UK and Australia. Participants Patients and caregivers, who had been admitted to critical care from three continents. Results 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems. Conclusions Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one's social network, economic security and access to healthcare is required following discharge from critical care.
AB - Objectives Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness. Design In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections. Setting 14 hospital sites in the USA, UK and Australia. Participants Patients and caregivers, who had been admitted to critical care from three continents. Results 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems. Conclusions Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one's social network, economic security and access to healthcare is required following discharge from critical care.
KW - adult intensive & critical care
KW - public health
KW - qualitative research
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U2 - 10.1136/bmjopen-2021-060454
DO - 10.1136/bmjopen-2021-060454
M3 - Article
C2 - 36167379
AN - SCOPUS:85138544149
SN - 2044-6055
VL - 12
JO - BMJ open
JF - BMJ open
IS - 9
M1 - e060454
ER -