Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study

McPeake, J. et al. (2022) Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study. BMJ Open, 12(9), e060454. (doi: 10.1136/bmjopen-2021-060454) (PMID:36167379) (PMCID:PMC9516069)

Abstract

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.

• Item Type: Articles
• Additional Information: Haines, J McPeake, L Boehm, C Sevin and Tara Quasim received funding from SCCM to undertake this work (No award number). L Boehm is funded by NIH/NHLBI (K12 HL137943) as is T J Iwashyna (K12 HL138039). J McPeake is funded by a THIS.Institute (University of Cambridge) Fellowship (PD- 2019-02-16/307748-01).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quasim, Professor Tara and McPeake, Dr Jo
• Authors: McPeake, J., Boehm, L., Hibbert, E., Hauschildt, K., Bakhru, R., Bastin, A., Butcher, B., Eaton, T., Harris, W., Hope, A., Jackson, J., Johnson, A., Kloos, J., Korzick, K., McCartney, J., Meyer, J., Montgomery-Yates, A., Quasim, T., Slack, A., Wade, D., Still, M., Netzer, G., Hopkins, R. O., Mikkelsen, M. E., Iwashyna, T., Haines, K., and Sevin, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 27 September 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in BMJ Open 12(9): e060454
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
307748		Improving health and social care integration delivery in the acute care environment	Joanne McPeake	University of Cambridge (HEI-CAMB)	RG88620	HW - MRC/CSO Social and Public Health Sciences Unit