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Original research
Fragmentation of care between intensive and primary care settings and opportunities for improvement
  1. Nina Leggett1,2,
  2. Kate Emery2,
  3. Thomas C Rollinson3,4,
  4. Adam Deane1,5,
  5. Craig French6,
  6. Jo-Anne Manski Nankervis7,
  7. Glenn Eastwood8,
  8. Briannah Miles5,
  9. Mark Merolli4,9,
  10. Yasmine Ali Abdelhamid1,5,
  11. Kimberley Joy Haines1,2
  1. 1 Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
  3. 3 Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
  4. 4 Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Department of Intensive Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
  6. 6 Department of Intensive Care, Western Health, Footscray, Victoria, Australia
  7. 7 Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
  8. 8 Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
  9. 9 Centre for Digital Transformation of Health, The University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Nina Leggett, Department of Critical Care, The University of Melbourne, Parkville, Victoria, Australia; nleggett{at}; A/Prof Kimberley Joy Haines; kimberley.haines{at}


Purpose To explore the gaps in care provided across the transitions from the intensive care unit (ICU) to primary care, in order to improve post-ICU care.

Methods Semistructured interviews with three participant groups: intensivists, general practitioners (GPs) and patients and carers with framework analysis of textual data were used to investigate experiences of transitions of care post-ICU. Participants were purposively sampled for diversity. Eligible patients were adults, mechanically ventilated for >24 hours, with access to a video-enabled device. Exclusion criteria were non-English speaking and any cognitive/neurological limitation precluding interview participation.

Results A total of 46 interviews (15 patients, 8 caregivers, 15 intensivists and 8 GPs) were completed. Eight themes were identified, and categorised into three healthcare tiers. Tier 1, health system factors: (1) fragmentation of care; (2) communication gaps; (3) limited awareness and recognition of issues beyond the ICU; (4) lack of a specialised ICU follow-up pathway; Tier 2, clinician factors: (5) relationships among ICU, hospitals, GPs and patients and carers; (6) need for clinician role definition and clarity in ICU follow-up; Tier 3, patient and carer factors: (7) patient autonomy and self-actualisation and (8) the evolving caregiver role. A conceptual model was developed, highlighting bidirectional feedback loops between hospital and primary care.

Conclusion This study identified gaps in care between ICU discharge and reintegration with primary care from the lived experience of patients, caregivers, intensivists and GPs. These data provide foci for future interventional research to improve the integration of care for this vulnerable and underserved cohort.

  • Critical Care

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @ninaleggett, @HainesKimberley

  • Contributors NL is the main author and study guarantor. Study conception and design was completed by KJH, NL, YA and AD. Data collection was completed by NL, BM, KE and TCR. Data analysis was completed by NL, KE, TCR and KJH. The primary manuscript was written by NL. KE, TCR, AD, CF, J-AMN, GE, BM, MM, YAA and KJH contributed to manuscript review and approval of the submitted manuscript. Supervision was provided by AD, KJH, YA and MM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.