(785) Modification of Social Determinants of Health Following Critical Illness

Introduction: Half of intensive care (ICU) unit survivors experience post-intensive care syndrome (PICS), a constellation of physical, emotional, and cognitive sequelae when recovering from a critical illness treated in an ICU. Growing evidence suggests health disparities and health inequities in post-ICU outcomes. Because Canadian healthcare is provided within a universal publicly-funded system, this analysis sheds light on the role of social determinants of health in the context of a social safety net, including universal health services.

Methods: A qualitative, interpretive description methodology was used to analyze semi-structured interview transcripts with survivors, family caregivers, and healthcare providers (HCPs). Survivor and caregiver participants were recruited from a 46-bed ICU of a large urban hospital in British Columbia, Canada and HCPs from the broader regional health authority. The research team was an interdisciplinary group of researchers, clinicians, clinician-scientists, healthcare decision-makers, patient partners (individuals with lived experience), and trainees.

Results: Narratives from 30 ICU survivors (mean age 58, 18 men and 12 women), 25 family caregivers (mean age 55, 8 men and 17 women) and 19 HCPs (mean age 42, 7 men and 12 women) illustrated how social determinants of health, namely challenges with employment and finances, home set-up, transportation, food insecurity and nutritional challenges, medications, and social support, complicated and impeded critical illness recovery. These social determinants of health were modified by critical illness sequelae, creating or exacerbating socioeconomic disadvantage during recovery, especially for individuals facing pre-existing socioeconomic challenges. Our findings highlighted the fragile connection between healthcare and social services, as well as the challenges faced by acute care in prioritizing assessments before discharge.

Conclusions: Addressing health disparities and the social determinants of health highlighted in our study is crucial for improving the overall quality of care and support provided in hospital-to-home care recovery. Devising means of identifying risks of socioeconomic disadvantage and delivering socioeconomic support throughout the critical illness recovery trajectory are warranted.