• Konrad Fr Schmidt, Daniel Schwarzkopf, Laura-Mae Baldwin, Frank M Brunkhorst, Antje Freytag, Christoph Heintze, Konrad Reinhart, Nico Schneider, Michael von Korff, Susanne Worrack, Michel Wensing, Jochen Gensichen, and SMOOTH Study Group.
• Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany. Electronic address: Konrad.Schmidt@charite.de.
• Am. J. Med. 2020 Mar 1; 133 (3): 381-385.e5.

BackgroundSepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.MethodsThis study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.ResultsOne hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups.ConclusionsTwelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.Copyright © 2019 Elsevier Inc. All rights reserved.

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