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Unmet Nonmedication Needs After Hospital Discharge and Adverse Outcomes Among Acute Respiratory Failure Survivors in
Sérgio R R Decker1,2,3, Danielle do A Pereira4, Gabriela S Rech4
1Internal Medicine Department, Moinhos de Vento Hospital, Porto Alegre, RS, Brazil.
Importance:
In-hospital survivorship for acute respiratory failure has improved, but unmet nonmedication healthcare needs may contribute to adverse events post-discharge.
Objectives:
To evaluate the feasibility of characterizing early unmet nonmedication discharge needs, classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUA) for acute respiratory failure survivors in Brazil. Secondary objectives include describing the profile of needs, unmet needs, and adverse outcomes post-discharge.
Design:
Prospective feasibility cohort study, with enrollment between October 2020 and March 2021.
Setting:
One tertiary teaching hospital from Southern Brazil with 76 ICU beds.
Participants:
Adult survivors from acute respiratory failure who were discharged home.
Main Outcomes And Measures:
Our primary outcome was the feasibility of measuring unmet nonmedication needs between 7 and 28 days post-discharge, considering greater than 80% of data completeness as feasible. Secondary outcomes included the characterization of needs and needs unmet per type at 1 month and the crude risk of all-cause death, hospital readmission, and urgent visits to the emergency department at 3 months post-discharge.
Results:
Of 337 patients screened, 72 were enrolled, and data on unmet nonmedication needs were collected from 66 patients, resulting in a primary feasibility outcome of 91.7%. The median age was 59 years, 38.9% were female, most were self-declared White, and were employed before admission. During the index admission, 87.3% were diagnosed with COVID-19, and 79.2% received invasive mechanical ventilation. The frequency of nonmedication discharge needs was 48 (72.7%) for DME, 54 (81.8%) for HHS, and 60 (90.9%) for FUA. At 1 month, 36 (58.1%) had at least one need unmet; at 3 months, 12 (19.0%) had at least one adverse outcome.
Conclusions And Relevance:
Detailed measurement of nonmedication needs post-discharge for acute respiratory failure survivors in Brazil is feasible. Unmet nonmedication needs are a common problem to be addressed in this population.
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