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Paul C, Schöttker B, Hartmann M, Friederich HC, Brenner H, Wild B. Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study. Int J Geriatr Psychiatry 2024; 39:e6113. [PMID: 38877644 DOI: 10.1002/gps.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.
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Affiliation(s)
- Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
- DZPG German Centre for Mental Health-Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
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de Oliveira CA, Weber B, de Camargo LL, Balco EM, Barros MA, Zanetti ACG, Lobo E, Rzewuska M, de Azevedo-Marques JM. INTERMED's reliability to assess health complexity in primary care: A Brazilian cross-section study. Gen Hosp Psychiatry 2023; 81:89-90. [PMID: 36732206 DOI: 10.1016/j.genhosppsych.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - Lisa Laredo de Camargo
- Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Estenifer Marque Balco
- Public Health Postgraduate Program, Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Michel Arantes Barros
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Center for Nursing Research Development, São Paulo, Brazil
| | - Elena Lobo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Spain; Aragon Health Research Institute (IIS-A), Spain
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Center for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Brenne BA, Hedlund M, Ingstad K. Exploring home-based care nurses' mindset for nursing practices: a phenomenological study. BMC Nurs 2022; 21:291. [PMID: 36316738 PMCID: PMC9623960 DOI: 10.1186/s12912-022-01068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. Methods This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. Results The analysis revealed three main patterns that characterise nursing practices in home care: ‘To be vigilant’, ‘To be an all-rounder’, and ‘To act with independence’. The content and distinction of these patterns are discussed through a theoretical framework of ‘clinical mindlines’. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. Conclusion Nurses’ vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses’ practical knowledge and the importance of mindlines.
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Affiliation(s)
- Bodil Aarmo Brenne
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
| | - Marianne Hedlund
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway ,grid.5947.f0000 0001 1516 2393Department of Social Work, NTNU, 7491 Trondheim, Norway
| | - Kari Ingstad
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
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de Oliveira CA, Weber B, dos Santos JLF, Zucoloto ML, de Camargo LL, Zanetti ACG, Rzewuska M, de Azevedo-Marques JM. Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool. PLoS One 2022; 17:e0263702. [PMID: 35180262 PMCID: PMC8856552 DOI: 10.1371/journal.pone.0263702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
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Affiliation(s)
- Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Bernardete Weber
- Registered Nurse, Hospital do Coração (HCor), São Paulo City, Brazil
| | | | - Miriane Lucindo Zucoloto
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lisa Laredo de Camargo
- Postgraduate Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Centre for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Nicolaus S, Crelier B, Donzé JD, Aubert CE. Definition of patient complexity in adults: A narrative review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221081288. [PMID: 35586038 PMCID: PMC9106317 DOI: 10.1177/26335565221081288] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
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Affiliation(s)
- Stefanie Nicolaus
- Department of General Internal Medicine, Biel Hospital, Biel, Switzerland
| | - Baptiste Crelier
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
| | - Jacques D Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Corminboeuf Y, Wild B, Zdrojewski C, Schellberg D, Favre L, Suter M, Stiefel F. BMI Course Over 10 Years After Bariatric Surgery and Biopsychosocial Complexity Assessed with the INTERMED: a Retrospective Study. Obes Surg 2021; 31:3996-4004. [PMID: 33982239 PMCID: PMC8397640 DOI: 10.1007/s11695-021-05440-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/04/2022]
Abstract
Background While bariatric surgery is an effective therapy for patients with severe obesity, not all patients benefit equally. An explanation might be that psychosocial risk factors hamper outcome. The study aimed to evaluate if biopsychosocial case complexity predicts evolution of BMI over 10 years after bariatric surgery. Methods Charts of patients (N = 236) of the Cohort of Obesity Lausanne (COOL) were retrospectively reviewed and rated with the INTERMED, a reliable and validated instrument, which assesses biopsychosocial case complexity and has been proven to predict outcome of medical treatments in different patient populations. The sample was stratified into BMI quartiles, computed from the patients’ baseline BMI. For each quartile, BMI evolution was analyzed using individual growth curve analysis. Results Growth curve analyses showed that in quartiles 1, 2, and 3, none of the INTERMED domain scores significantly predicted the BMI evolution after surgery. However, in the fourth quartile—including patients with the highest pre-surgical BMI—the social domain score of the INTERMED significantly predicted BMI evolution: patients with more social complexity showed higher increase in BMI. Conclusion Effectiveness of interventions targeted at social complexity, especially when patients suffer from severe obesity, may therefore be evaluated in future studies. Graphical abstract ![]()
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Affiliation(s)
- Yann Corminboeuf
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Catherine Zdrojewski
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Lucie Favre
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Busnel C, Vallet F, Ludwig C. Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI-HC. Nurs Open 2021; 8:815-823. [PMID: 33570265 PMCID: PMC7877136 DOI: 10.1002/nop2.686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
AIM Home care nurses often use the Resident Assessment Instrument-Home Care (interRAI-HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI-HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). DESIGN Data were collected at the baseline assessment of the fraXity study (N = 231, aged ≥ 65), which relied on an observational longitudinal design. METHODS Measures were the interRAI-HC, from which the CI binary variables were computed and the COMID, used as a reference. RESULTS Twenty-six CI variables were computed from the interRAI-HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 (p < .001). CONCLUSIONS The study demonstrates that complexity can be assessed directly from the interRAI-HC by deriving a CI.
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Affiliation(s)
- Catherine Busnel
- Research and Development UnitGeneva Institution for Homecare and Assistance (imad)CarougeSwitzerland
| | - Fanny Vallet
- Research and Development UnitGeneva Institution for Homecare and Assistance (imad)CarougeSwitzerland
| | - Catherine Ludwig
- Geneva School of Health Sciences, HES‐SOUniversity of Applied Sciences and Arts Western SwitzerlandGenevaSwitzerland
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Ferrari S, Mattei G, Marchi M, Galeazzi GM, Pingani L. Is Consultation-Liaison Psychiatry 'Getting Old'? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207389. [PMID: 33050480 PMCID: PMC7601334 DOI: 10.3390/ijerph17207389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.
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Affiliation(s)
- Silvia Ferrari
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Giorgio Mattei
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Economics “Marco Biagi”, University of Modena and Reggio Emilia, Via Jacopo Berengario 51, 41121 Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Luca Pingani
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Health Professions, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-522077
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Leue C, van Schijndel M, Keszthelyi D, van Koeveringe G, Ponds R, Kathol R, Rutten B. The multi-disciplinary arena of psychosomatic medicine – Time for a transitional network approach. EUROPEAN JOURNAL OF PSYCHIATRY 2020. [DOI: 10.1016/j.ejpsy.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs. J Psychosom Res 2019; 119:26-33. [PMID: 30947814 DOI: 10.1016/j.jpsychores.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. METHODS We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. RESULTS Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. CONCLUSIONS The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.
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Wand AP, Sharma S, Carpenter LJ, Gatsi M. Development of an operational manual for a consultation-liaison psychiatry service. Australas Psychiatry 2018; 26:503-507. [PMID: 29457469 DOI: 10.1177/1039856218758563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Consultation-liaison psychiatry (CLP) services sit between mental health and the general hospital, and risk being poorly understood by both systems. The aim of this study was to develop an operational manual for a CLP service, which defined functions and governance. METHODS The CLP literature was reviewed with a focus on descriptions of CLP roles, organisational processes, quality measures and service development. The CLP team held service planning meetings and met with members of the mental health and hospital executives. Site visits and collaboration with other CLP services occurred in defining the roles of the CLP service and organisational governance. RESULTS A CLP operational document was developed, including a description of the service, its functions, staff roles and governance. Procedural information such as the CLP timetable, referral process, triage and assessment, documentation, activity recording, quality assurance and relevant policies were outlined. CONCLUSIONS The development of a dedicated operational manual for CLP clarified the roles, functions and governance of CLP within the general hospital and mental health systems. The development process facilitated the engagement of key clinicians and administrators of these systems, the determination of quality improvement targets and greater transparency and accountability.
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Affiliation(s)
- Anne Pf Wand
- Staff Specialist Psychiatrist, Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Eastern Suburbs Mental Health Service, Randwick, NSW, and; Conjoint Senior Lecturer, School of Psychiatry, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Swapnil Sharma
- Senior Staff Specialist Psychiatrist, Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Eastern Suburbs Mental Health Service, Randwick, NSW, and; Conjoint Senior Lecturer, School of Psychiatry, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Lindsay J Carpenter
- Staff Specialist Psychiatrist, Department of Consultation-Liaison Psychiatry, Prince of Wales Hospital, Eastern Suburbs Mental Health Service, Randwick, NSW, and; Conjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of NSW, Sydney, NSW, Australia
| | - Mike Gatsi
- Service Director, Eastern Suburbs Mental Health Service, Randwick, NSW, Australia
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Busnel C, Marjollet L, Perrier-Gros-Claude O. Complexité des prises en soins à domicile : développement d’un outil d’évaluation infirmier et résultat d’une étude d’acceptabilité. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.refiri.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thurber S, Wilson A, Realmuto G, Specker S. The relationship between the INTERMED patient complexity instrument and Level of Care Utilisation System (LOCUS). Int J Psychiatry Clin Pract 2018; 22:80-82. [PMID: 28691596 DOI: 10.1080/13651501.2017.1353635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the concurrent and criterion validity of two independently developed measurement instruments, INTERMED and LOCUS, designed to improve the treatment and clinical management of patients with complex symptom manifestations. METHODS Participants (N = 66) were selected from hospital records based on the complexity of presenting symptoms, with tripartite diagnoses across biological, psychiatric and addiction domains. Biopsychosocial information from hospital records were submitted to INTERMED and LOCUS grids. In addition, Global Assessment of Functioning (GAF) ratings were gathered for statistical analyses. RESULTS The product moment correlation between INTERMED and LOCUS was 0.609 (p = .01). Inverse zero-order correlations for INTERMED and LOCUS total score and GAF were obtained. However, only the beta weight for LOCUS and GAF was significant. An exploratory principal components analysis further illuminated areas of convergence between the instruments. CONCLUSIONS INTERMED and LOCUS demonstrated shared variance. INTERMED appeared more sensitive to complex medical conditions and severe physiological reactions, whereas LOCUS findings are more strongly related to psychiatric symptoms. Implications are discussed.
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Affiliation(s)
- Steven Thurber
- a Psychiatry, Child and Adolescent Behavior Health Services , Minnesota Department of Human Services , Willmar , MN , USA
| | - Ann Wilson
- b Department of Psychiatry , University of Minnesota, Minneapolis , MN , USA
| | - George Realmuto
- b Department of Psychiatry , University of Minnesota, Minneapolis , MN , USA
| | - Sheila Specker
- b Department of Psychiatry , University of Minnesota, Minneapolis , MN , USA
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Boehlen FH, Herzog W, Schellberg D, Maatouk I, Saum KU, Brenner H, Wild B. Self-perceived coping resources of middle-aged and older adults - results of a large population-based study. Aging Ment Health 2017; 21:1303-1309. [PMID: 27571476 DOI: 10.1080/13607863.2016.1220918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Psychosocial resources (personal resources, social resources, and other) are important for coping with aging and impairment. The aim of this study was to describe the resources of older adults and to compare subgroups with frailty, complex health care needs, and/or mental disorders. METHOD At the third follow-up of the large population-based German ESTHER study, 3124 elderly persons (aged 55-85) were included. Psychosocial resources were assessed during a home visit by trained study doctors by using a list of 26 different items. Resources were described for the total group, separated by sex, and for the three subgroups of persons with frailty, complex health care needs, and mental disorders. RESULTS Family, self-efficacy, and financial security were the most frequently reported resources of older adults. Women and men showed significant differences in their self-perceived resources. Personal resources (self-efficacy, optimism, mastery), social resources, and financial security were reported significantly less frequently by frail persons, persons with complex health care needs, and mentally ill older adults compared to non-impaired participants. Apart from external support, patients who experienced complex health care needs reported resources less frequently compared to frail and mentally ill patients. CONCLUSION Coping resources in older adults are associated with sex and impairment. Evaluation and support of personal resources of frail or mentally ill persons or individuals with complex health care needs should be integrated in the therapeutic process.
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Affiliation(s)
- Friederike H Boehlen
- a Department of General Internal Medicine and Psychosomatics , Medical University Hospital , Heidelberg , Germany
| | - Wolfgang Herzog
- a Department of General Internal Medicine and Psychosomatics , Medical University Hospital , Heidelberg , Germany
| | - Dieter Schellberg
- a Department of General Internal Medicine and Psychosomatics , Medical University Hospital , Heidelberg , Germany
| | - Imad Maatouk
- a Department of General Internal Medicine and Psychosomatics , Medical University Hospital , Heidelberg , Germany
| | - Kai-Uwe Saum
- b Division of Clinical Epidemiology and Aging Research, German Cancer Research Center , Heidelberg , Germany
| | - Hermann Brenner
- b Division of Clinical Epidemiology and Aging Research, German Cancer Research Center , Heidelberg , Germany
| | - Beate Wild
- a Department of General Internal Medicine and Psychosomatics , Medical University Hospital , Heidelberg , Germany
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Bujold M, Pluye P, Légaré F, Haggerty J, Gore GC, Sherif RE, Poitras MÈ, Beaulieu MC, Beaulieu MD, Bush PL, Couturier Y, Débarges B, Gagnon J, Giguère A, Grad R, Granikov V, Goulet S, Hudon C, Kremer B, Kröger E, Kudrina I, Lebouché B, Loignon C, Lussier MT, Martello C, Nguyen Q, Pratt R, Rihoux B, Rosenberg E, Samson I, Senn N, Li Tang D, Tsujimoto M, Vedel I, Ventelou B, Wensing M. Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol. BMJ Open 2017; 7:e016400. [PMID: 29133314 PMCID: PMC5695438 DOI: 10.1136/bmjopen-2017-016400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/28/2017] [Accepted: 08/23/2017] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). METHODS AND ANALYSIS This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). ETHICS AND DISSEMINATION This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. PROSPERO REGISTRATION NUMBER CRD42015020558.
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Affiliation(s)
- Mathieu Bujold
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | - Reem El Sherif
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Marie-Ève Poitras
- Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada
| | | | | | - Paula L Bush
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Couturier
- École de travail social, Université de Sherbrooke, Canada
| | | | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Anik Giguère
- Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Vera Granikov
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Serge Goulet
- Department of Family Medicine, Université de Sherbrooke, Canada
| | - Catherine Hudon
- Department of Family Medicine, Université de Sherbrooke, Canada
| | | | | | - Irina Kudrina
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | | | - Cristiano Martello
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Quynh Nguyen
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, United States
| | - Benoit Rihoux
- Centre de Science Politique et de Politique Comparée, Université catholique de Louvain, Belgium
| | - Ellen Rosenberg
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Isabelle Samson
- Department of Family Medicine and Emergency Medicine, Université Laval, Montréal, Québec, Canada
| | | | - David Li Tang
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
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Maglogiannis I, Andrikos C, Rassias G, Tsanakas P. A DICOM Based Collaborative Platform for Real-Time Medical Teleconsultation on Medical Images. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 989:79-91. [DOI: 10.1007/978-3-319-57348-9_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Assessment of Biopsychosocial Complexity and Health Care Needs: Measurement Properties of the INTERMED Self-Assessment Version. Psychosom Med 2017; 79:485-492. [PMID: 28033198 DOI: 10.1097/psy.0000000000000446] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSA within a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). METHODS A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach α; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. RESULTS Feasibility, face validity, and reliability (Cronbach α = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was .78 (95% CI = .75-.81). Correlations of the IMSA with the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were -.65, .15, .28, and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3- and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. CONCLUSIONS The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.
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van Eck van der Sluijs JF, de Vroege L, van Manen AS, Rijnders CAT, van der Feltz-Cornelis CM. Complexity Assessed by the INTERMED in Patients With Somatic Symptom Disorder Visiting a Specialized Outpatient Mental Health Care Setting: A Cross-sectional Study. PSYCHOSOMATICS 2017; 58:427-436. [PMID: 28347505 DOI: 10.1016/j.psym.2017.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Somatic symptom disorders (SSD), a new classification in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition is associated with problematic diagnostic procedures and treatment that lead to complex care. In somatic health care, the INTERMED has been used to assess levels of complexity; however, in SSD this instrument has not yet been applied. OBJECTIVE This study aims to explore complexity in patients with SSD using the INTERMED, hereby contributing to an increased comprehension of this new patient group. METHOD In this cross-sectional study, the INTERMED was used to assess complexity in outpatients with SSD at the Clinical Centre of Excellence for Body, Mind, and Health (The Netherlands), along biologic, psychologic, social, and health care domains. This was done retrospectively with patient files from consecutive patients from 2011 until 2015. RESULTS In the total SSD sample (N = 187), 63% was female, the mean age (standard deviation) was 42 (±12.4) years, with an average educational level. The mean INTERMED score was 23.5 indicating high overall complexity in this population. A high proportion of our sample (69%) scored as highly complex (>20). High complexity was associated with higher depression and anxiety scores, but not with a higher number of physical symptoms. CONCLUSIONS This study demonstrates that patients with SSD form a high-complex group, with higher scores compared with literature about multiple sclerosis, rheumatoid arthritis, or patient waiting for a liver transplant. INTERMED outcomes indicate a need for extensive diagnostic procedures and integrated multidisciplinary care for patients with SSD. Attention should especially be paid to mental disorders (depression and anxiety), given their association with high complexity.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands.
| | - Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Annick S van Manen
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
| | | | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands
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Andrikos C, Rassias G, Tsanakas P, Maglogiannis I. Real-time medical collaboration services over the web. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:1393-6. [PMID: 26736529 DOI: 10.1109/embc.2015.7318629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The gradual shift in modern medical practice, from working alone clinical doctors to MDTs (Multi-Disciplinary Teams), raises the need of online real-time collaboration among geographically distributed medical personnel. The paper presents a Web-based platform, featuring an efficient medical data management and exchange, for hosting real-time collaborative services. The presented work leverages state-of-the-art features of the web (technologies and APIs) to support client-side medical data processing. Moreover, to address the typical bandwidth bottleneck and known scalability issues of centralized data sharing, an indirect RPC (Remote Process Call) scheme is introduced through object synchronization over the WebRTC paradigm.
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Ruiz M, Bottle A, Long S, Aylin P. Multi-Morbidity in Hospitalised Older Patients: Who Are the Complex Elderly? PLoS One 2015; 10:e0145372. [PMID: 26716440 PMCID: PMC4696783 DOI: 10.1371/journal.pone.0145372] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/01/2015] [Indexed: 12/21/2022] Open
Abstract
Background No formal definition for the “complex elderly” exists; moreover, these older patients with high levels of multi-morbidity are not readily identified as such at point of hospitalisation, thus missing a valuable opportunity to manage the older patient appropriately within the hospital setting. Objectives To empirically identify the complex elderly patient based on degree of multi-morbidity. Design Retrospective observational study using administrative data. Setting English hospitals during the financial year 2012–13. Subjects All admitted patients aged 65 years and over. Methods By using exploratory analysis (correspondence analysis) we identify multi-morbidity groups based on 20 target conditions whose hospital prevalence was ≥ 1%. Results We examined a total of 2788900 hospital admissions. Multi-morbidity was highly prevalent, 62.8% had 2 or more of the targeted conditions while 4.7% had six or more. Multi-morbidity increased with age from 56% (65-69yr age-groups) up to 67% (80-84yr age-group). The average multi-morbidity was 3.2±1.2 (SD). Correspondence analysis revealed 3 distinct groups of older patients. Group 1 (multi-morbidity ≤2), associated with cancer and/or metastasis; Group 2 (multi-morbidity of 3, 4 or 5), associated with chronic pulmonary disease, lung disease, rheumatism and osteoporosis; finally Group 3 with the highest level of multi-morbidity (≥6) and associated with heart failure, cerebrovascular accident, diabetes, hypertension and myocardial infarction. Conclusions By using widely available hospital administrative data, we propose patients in Groups 2 and 3 to be identified as the complex elderly. Identification of multi-morbidity patterns can help to predict the needs of the older patient and improve resource provision.
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Affiliation(s)
- Milagros Ruiz
- Dr Foster Unit at Imperial, Dept. Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London, W6 6RP, United Kingdom
- * E-mail:
| | - Alex Bottle
- Dr Foster Unit at Imperial, Dept. Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London, W6 6RP, United Kingdom
| | - Susannah Long
- Department of Medicine for the Elderly, Cambridge Wing, St Mary's Campus, Imperial College London, Praed Street, London, W2 1NY, United Kingdom
| | - Paul Aylin
- Dr Foster Unit at Imperial, Dept. Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, St. Dunstan's Road, London, W6 6RP, United Kingdom
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Long N, Yerly C, Perey L. Mesure de la complexité de la prise en charge et de l’évaluation contextuelle du patient dans un service d’oncologie ambulatoire, une approche novatrice avec INTERMED. PSYCHO-ONCOLOGIE 2015. [DOI: 10.1007/s11839-015-0515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Care coordination of multimorbidity: a scoping study. JOURNAL OF COMORBIDITY 2015; 5:15-28. [PMID: 29090157 PMCID: PMC5636034 DOI: 10.15256/joc.2015.5.39] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 03/05/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework. OBJECTIVE The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals. DESIGN The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care. RESULTS The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity). CONCLUSIONS In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.
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Assessing psychosocial vulnerability and care needs of pretransplant patients by means of the INTERMED. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2014; 60:190-203. [PMID: 24877575 DOI: 10.13109/zptm.2014.60.2.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. METHOD One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). RESULTS We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. CONCLUSIONS The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.
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Predicting non return to work after orthopaedic trauma: the Wallis Occupational Rehabilitation RisK (WORRK) model. PLoS One 2014; 9:e94268. [PMID: 24718689 PMCID: PMC3981787 DOI: 10.1371/journal.pone.0094268] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/14/2014] [Indexed: 01/01/2023] Open
Abstract
Background Workers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker’s background. Methods Prospective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients’ data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests. Results At 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate. Conclusions Non-RTW may be predicted with a simple model constructed with variables independent of the patient’s education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers.
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Oeseburg B, Hilberts R, Luten TA, van Etten AVM, Slaets JPJ, Roodbol PF. Interprofessional education in primary care for the elderly: a pilot study. BMC MEDICAL EDUCATION 2013; 13:161. [PMID: 24308766 PMCID: PMC4029384 DOI: 10.1186/1472-6920-13-161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 11/26/2013] [Indexed: 05/30/2023]
Abstract
BACKGROUND The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of nurses and physicians required to meet this demand.At present, the main focus of health care in the Netherlands lies on illness and treatment. However, (frail) elderly need care and support that takes their daily functioning and well-being into consideration as well. Therefore, health care professionals, especially those professionals working in primary care such as GPs and practice nurses, will be challenged to a paradigm shift in emphasis from treating illness to promoting health (healthy ageing). Interprofessional education is necessary to realise this shift in professional behaviour. Evidence indicates that interprofessional education (IPE) can play a pivotal role in enhancing the competencies of professionals in order to provide elderly care that is both effectively, integrated and well-coordinated. At present, however, IPE in primary care is rarely utilised in the Netherlands. Therefore, the aim of this pilot study was to develop an IPE program for GPs and practice nurses and to evaluate the feasibility of an IPE program for professionals with different educational backgrounds and its effect on the division of professionals' tasks and responsibilities. METHODS Ten GPs and 10 practice nurses from eight primary care practices in two provinces in the north of the Netherlands, Groningen and Drenthe (total population about 1.1 million people), participated in the pilot IPE program. A mixed methods design including quantitative and qualitative methods was used to evaluate the IPE program. RESULTS During the program, tasks and responsibilities, in particular those related to the care plan, shifted from GP to practice nurse. The participants' attitude toward elderly (care) changed and the triage instrument, the practical tool for prioritising preferences of the elderly and discussing their medication use, was considered to have an added value to the development of the care plan. CONCLUSIONS The results of this pilot study show that an interprofessional education program for professionals with different educational backgrounds (GPs and practice nurses) is feasible and has an added value to the redefining of tasks and responsibilities among GPs and practice nurses.
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Affiliation(s)
- Barth Oeseburg
- Wenckebach Institute, School of Nursing and Health, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Rudi Hilberts
- Wenckebach Institute Postgraduate School of Medicine, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Truus A Luten
- Primary Care Practice Stationsstraat Hoogeveen, Stationsstraat 6a, 7901 AB Hoogeveen, The Netherlands
| | - Antoinette VM van Etten
- University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Joris PJ Slaets
- Geriatric Medicine, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Petrie F Roodbol
- Wenckebach Institute, School of Nursing and Health, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Wenckebach Institute Postgraduate School of Medicine, University Medical Centre Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Peters LL, Boter H, Slaets JPJ, Buskens E. Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity. J Psychosom Res 2013; 74:518-22. [PMID: 23731750 DOI: 10.1016/j.jpsychores.2013.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The INTERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be provided as it supports professionals in their allocation decisions. The aim was to evaluate the measurement properties of the IM-E-SA. METHODS In this cross-sectional study 338 elderly people completed a postal questionnaire and participated in an interview. Feasibility of the IM-E-SA was assessed by determining the percentages of missing values per item. Reliability of the IM-E-SA was expressed as Cronbach's alpha. Intraclass correlation coefficients (ICCs) were calculated between the IM-E-SA and IM-E. Nonparametric tests were applied to assess if the IM-E-SA could distinguish between subgroups of elderly adults who differed on demographic characteristics and the prevalence of diseases/disorders. Convergent validity and discriminant validity were assessed using Spearman rank correlations between the IM-E-SA and IM-E, life satisfaction (Cantril's Ladder of Life), activities of daily living (Katz extended), quality of life (EQ-5D), mental health (SF-36) and prevalence of diseases/disorders. RESULTS Percentages of missing values per IM-E-SA item ranged from 0 to 5%. Cronbach's alpha was .78. The ICC between the total scores of the IM-E-SA and the IM-E was .68. The IM-E-SA yielded statistically significant differences between subgroups (known-group validity). Correlations evaluating the convergent validity were moderate to strong (.50-.70). Those correlations assessing the discriminant validity were moderate (.38-.53). CONCLUSION This study supports the feasibility, reliability and validity of the IM-E-SA.
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Affiliation(s)
- Lilian L Peters
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, The Netherlands.
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A review of cognitive therapy in acute medical settings. Part I: Therapy model and assessment. Palliat Support Care 2012; 11:141-53. [DOI: 10.1017/s147895151200082x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Although cognitive therapy (CT) has established outpatient utility, there is no integrative framework for using CT in acute medical settings where most psychosomatic medicine (P-M) clinicians practice. Biopsychosocial complexity challenges P-M clinicians who want to use CT as the a priori psychotherapeutic modality. For example, how should clinicians modify the data gathering and formulation process to support CT in acute settings?Method:Narrative review methodology is used to describe the framework for a CT informed interview, formulation, and assessment in acute medical settings. Because this review is aimed largely at P-M trainees and educators, exemplary dialogues model the approach (specific CT strategies for common P-M scenarios appear in the companion article.)Results:Structured data gathering needs to be tailored by focusing on cognitive processes informed by the cognitive hypothesis. Agenda setting, Socratic questioning, and adaptations to the mental state examination are necessary. Specific attention is paid to the CT formulation, Folkman's Cognitive Coping Model, self-report measures, data-driven evaluations, and collaboration (e.g., sharing the formulation with the patient.) Integrative CT-psychopharmacological approaches and the importance of empathy are emphasized.Significance of results:The value of implementing psychotherapy in parallel with data gathering because of time urgency is advocated, but this is a significant departure from usual outpatient approaches in which psychotherapy follows evaluation. This conceptual approach offers a novel integrative framework for using CT in acute medical settings, but future challenges include demonstrating clinical outcomes and training P-M clinicians so as to demonstrate fidelity.
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Söllner W, Schüssler G. New 'European Association of Psychosomatic Medicine' founded. J Psychosom Res 2012; 73:343-4. [PMID: 23062806 DOI: 10.1016/j.jpsychores.2012.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/10/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, General Hospital Nuremberg, Germany.
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Matzer F, Wisiak UV, Graninger M, Söllner W, Stilling HP, Glawischnig-Goschnik M, Lueger A, Fazekas C. Biopsychosocial health care needs at the emergency room: challenge of complexity. PLoS One 2012; 7:e41775. [PMID: 22952586 PMCID: PMC3429453 DOI: 10.1371/journal.pone.0041775] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 06/25/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment. METHODS During a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment. RESULTS Study participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters. CONCLUSIONS A standardized screening of biopsychosocial case complexity among 'frequent utilizers' of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.
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Affiliation(s)
- Franziska Matzer
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Ursula V. Wisiak
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Monika Graninger
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Wolfgang Söllner
- Department of Psychosomatics and Psychotherapy, General Hospital Nuremberg, Nuremberg, Germany
| | - Hans Peter Stilling
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Andreas Lueger
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
- * E-mail:
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Measurement Properties of the Groningen Frailty Indicator in Home-Dwelling and Institutionalized Elderly People. J Am Med Dir Assoc 2012; 13:546-51. [DOI: 10.1016/j.jamda.2012.04.007] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/08/2012] [Accepted: 04/17/2012] [Indexed: 11/21/2022]
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Lobo E, Rabanaque MJ, Bellido ML, Lobo A. Reliability of INTERMED Spanish version and applicability in liver transplant patients: a cross-sectional study. BMC Health Serv Res 2011; 11:160. [PMID: 21729313 PMCID: PMC3142204 DOI: 10.1186/1472-6963-11-160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 07/05/2011] [Indexed: 11/12/2022] Open
Abstract
Background Integrated delivery methods in healthcare systems have been proposed to confront the increasing complexity in general health care. INTERMED is an empirically derived, observer-rated instrument to measure case complexity. It was intended as a visualized, action-oriented decision-support tool for the early assessment of bio-psychosocial health risks and health needs. This study aims to document the reliability and applicability of the Spanish version of INTERMED in liver transplant patients. Methods Cross-sectional study of patients who had been included in the liver transplant waiting list. Two nurses interviewed the patients with INTERMED, and scored the instrument blind to each other. Kappa and w-kappa, Spearman, Kendall and intraclass correlation coefficients, and Cronbach's alfa were calculated. Results No patient refused the interview. Satisfactory coefficients were documented in most INTERMED items. Kappa was = 0.858 for the categorization of patients as "complex", and 21 of them (48.8%) were classified in this category, and were considered to need integrated treatment. Conclusions The Spanish version of INTERMED is reliable. Its applicability in liver transplant patients adds to its generalizability.
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Affiliation(s)
- Elena Lobo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain.
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Leentjens AFG, Lobo A. On the history of the European Association of Consultation-Liaison Psychiatry and Psychosomatics. J Psychosom Res 2011; 70:575-7. [PMID: 21624582 DOI: 10.1016/j.jpsychores.2011.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/11/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Centre, Maastricht, The Netherlands.
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[Towards integrated care. Nursing assessment of a "complex" patient using intermed]. ENFERMERIA CLINICA 2011; 20:309-12. [PMID: 20826103 DOI: 10.1016/j.enfcli.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 05/12/2010] [Accepted: 05/27/2010] [Indexed: 11/23/2022]
Abstract
Nurses are confronted with an increasing number of patients with complex health care needs. INTERMED (INTERdisciplinary MEDicine) is described here as an action oriented method to document the potential «complexity» of patients, summarising information on biological, psychological, social and health care domains, plotted on a time-axis (history, current state and prognoses). A 73 year old patient assessed with this tool on admission to an internal medicine ward is described. INTERMED identified that besides age, mental health problems were interfering with somatic state and identified the patient as a complex case. From an integral health care perspective, coordinated care was needed to focus on the psychological vulnerability of the patient that made the somatic state more complex, including all the health care providers involved. Complex patients are an important and interesting issue for today's nurses, challenging their ability for management, organisation and coordination of care beyond standard care and the INTERMED tool can be crucial in this development.
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Wild B, Lechner S, Herzog W, Maatouk I, Wesche D, Raum E, Müller H, Brenner H, Slaets J, Huyse F, Söllner W. Reliable integrative assessment of health care needs in elderly persons: the INTERMED for the Elderly (IM-E). J Psychosom Res 2011; 70:169-78. [PMID: 21262420 DOI: 10.1016/j.jpsychores.2010.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 09/10/2010] [Accepted: 09/20/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With the increasing prevalence of multiple conditions in older age, the high prevalence of mental disorders, and the many social challenges facing elderly people, a high-risk patient group in need of interdisciplinary (biological, psychological, and social) care is emerging. The INTERMED interview is an integrative assessment method that identifies patients with complex health care needs. The aim of this study was to develop and evaluate the INTERMED for the Elderly (IM-E), specifically for use in populations of elderly persons. METHODS In focus groups conducted with the authors of the original INTERMED, the variables and anchor points that had to be adjusted to the needs and situation of the elderly and to the demands of a population-based study were discussed and altered. The final version of the IM-E was conducted with 42 elderly persons. Participants were doubly scored by two trained raters; the interrater reliability [intraclass correlation coefficient (ICC) (2,1)] was calculated. RESULTS The IM-E was well accepted by the elderly persons interviewed. ICCs for the various domains of the IM-E ranged between .87 and .95, while the ICC for the sum score was .95. Regarding the cutoff point of 20/21 for patients with complex health care needs, a κ of .75 was achieved. CONCLUSIONS The IM-E is a reliable integrative assessment instrument. It is well suited for epidemiological settings to adequately describe the percentage of elderly patients with complex health care needs. In clinical settings, it can be used to identify elderly patients in need of interdisciplinary care.
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Affiliation(s)
- Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital of Heidelberg, Heidelberg, Germany.
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van der Kluit MJ, Goossens PJJ. Factors influencing attitudes of nurses in general health care toward patients with comorbid mental illness: an integrative literature review. Issues Ment Health Nurs 2011; 32:519-27. [PMID: 21767254 DOI: 10.3109/01612840.2011.571360] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An estimated 40% of patients in general health care settings suffer from a comorbid mental illness. A literature review was conducted to elucidate the factors underlying the different attitudes of nurses in general health care toward the nursing care of these patients. Although lack of knowledge, skills, and additional training with respect to dealing with patients with comorbid mental illness were frequently mentioned as a cause of negative attitudes, their exact relationships remained unclear. A holistic nursing vision, support, and older age were described as having a positive influence on a positive attitude, and workload was described as having a negative influence.
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Kishi Y, Matsuki M, Mizushima H, Matsuki H, Ohmura Y, Horikawa N. The INTERMED Japanese version: inter-rater reliability and internal consistency. J Psychosom Res 2010; 69:583-6. [PMID: 21109046 DOI: 10.1016/j.jpsychores.2010.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 02/13/2010] [Accepted: 02/19/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The intent of this study was to establish the inter-rater reliability and the internal consistency of the Japanese version of the INTERMED. METHODS The study included a series of patients referred to psychiatric consultation service or palliative care service. The study participants were independently scored using the INTERMED by the raters. RESULTS The INTERMED-Japanese version had high inter-rater reliability (intraclass correlation coefficient=0.98) and high internal consistency (alpha=.89). All four domains (biological, psychological, social, and health care domains) were positively correlated. Based on a cutoff score of 20/21, a κ of 0.79 was found. CONCLUSIONS The INTERMED is an easy and useful proactive biopsychosocial screening tool, which could be a reasonable utility under the current Japanese health care situations. Future studies focusing on the INTERMED utility in improving health care delivery for patients with complex biopsychosocial care needs has to be demonstrated in various medical settings in Japan.
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Affiliation(s)
- Yasuhiro Kishi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe-shi, Saitama, Japan.
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Freudenreich O, Kontos N, Querques J. The Muddles of Medicine: A Practical, Clinical Addendum to the Biopsychosocial Model. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70717-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adler RH. Engel's biopsychosocial model is still relevant today. J Psychosom Res 2009; 67:607-11. [PMID: 19913665 DOI: 10.1016/j.jpsychores.2009.08.008] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 08/18/2009] [Accepted: 08/18/2009] [Indexed: 02/08/2023]
Abstract
In 1977, Engel published the seminal paper, "The Need for a New Medical Model: A Challenge for Biomedicine" [Science 196 (1977) 129-136]. He featured a biopsychosocial (BPS) model based on systems theory and on the hierarchical organization of organisms. In this essay, the model is extended by the introduction of semiotics and constructivism. Semiotics provides the language which allows to describe the relationships between the individual and his environment. Constructivism explains how an organism perceives his environment. The impact of the BPS model on research, medical education, and application in the practice of medicine is discussed.
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Affiliation(s)
- Rolf H Adler
- Medical School, University of Berne, Berne, Switzerland.
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Consoli SM, Dantchev N, Vergnaud S, Lemogne C. Consultation-Liaison and Emergency Psychiatry. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2009. [DOI: 10.2753/imh0020-7411380403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. M. Consoli
- a C-L Psychiatry Department of European Georges Pompidou Hospital, Paris Descartes University of Medicine
| | - N. Dantchev
- b Adult Psychiatry Department, Hôtel-Dieu Hospital, Paris Descartes University of Medicine, Paris
| | - S. Vergnaud
- c Psychiatric Unit, Hôtel-Dieu General Hospital, Paris
| | - C. Lemogne
- d C-L Psychiatry Department, European Georges Pompidou Hospital
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Predictors of nonresponse in a questionnaire-based outcome study of vocational rehabilitation patients. Arch Phys Med Rehabil 2009; 90:1499-505. [PMID: 19735777 DOI: 10.1016/j.apmr.2009.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/20/2009] [Accepted: 03/12/2009] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To identify predictors of nonresponse to a self-report study of patients with orthopedic trauma hospitalized for vocational rehabilitation between November 15, 2003, and December 31, 2005. The role of biopsychosocial complexity, assessed using the INTERMED, was of particular interest. DESIGN Cohort study. Questionnaires with quality of life, sociodemographic, and job-related questions were given to patients at hospitalization and 1 year after discharge. Sociodemographic data, biopsychosocial complexity, and presence of comorbidity were available at hospitalization (baseline) for all eligible patients. Logistic regression models were used to test a number of baseline variables as potential predictors of nonresponse to the questionnaires at each of the 2 time points. SETTING Rehabilitation clinic. PARTICIPANTS Patients (N=990) hospitalized for vocational rehabilitation over a period of 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Nonresponse to the questionnaires was the binary dependent variable. RESULTS Patients with high biopsychosocial complexity, foreign native language, or low educational level were less likely to respond at both time points. Younger patients were less likely to respond at 1 year. Those living in a stable partnership were less likely than singles to respond at hospitalization. Sex, psychiatric, and somatic comorbidity and alcoholism were never associated with nonresponse. CONCLUSIONS We stress the importance of assessing biopsychosocial complexity to predict nonresponse. Furthermore, the factors we found to be predictive of nonresponse are also known to influence treatment outcome and vocational rehabilitation. Therefore, it is important to increase the response rate of the groups of concern in order to reduce selection bias in epidemiologic investigations.
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Kathol RG, Kunkel EJS, Weiner JS, McCarron RM, Worley LLM, Yates WR, Summergrad P, Huyse FJ. Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface. PSYCHOSOMATICS 2009; 50:93-107. [PMID: 19377017 DOI: 10.1176/appi.psy.50.2.93] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use. METHOD The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties. CONCLUSION Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.
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Affiliation(s)
- Roger G Kathol
- Dept. of Internal Medicine and Psychiatry, Univ. of Minnesota, USA.
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Huyse FJ. Farewell to C-L? Time for a change? J Psychosom Res 2009; 66:541-4. [PMID: 19446716 DOI: 10.1016/j.jpsychores.2009.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Frits J Huyse
- Consultant Integrated Care, P.C. Hooftstraat 157, 1071 BV Amsterdam, The Netherlands.
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Integrating care for persons, not only diseases. J Clin Psychol Med Settings 2009; 16:13-20. [PMID: 19259794 DOI: 10.1007/s10880-009-9154-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/05/2009] [Indexed: 12/21/2022]
Abstract
Integrated care is geared toward enhancing usual care and decision-making for common combinations of medical and mental health conditions, including the behavioral health and behavioral change aspects. Yet even with comprehensive and well-integrated care for health conditions and well-coordinated teamwork in place, some patients do not engage or respond to care in the way clinicians would like or predict. This troubles patients and clinicians alike and may be chalked up informally to things like medical complexity (multiple co-existing conditions), mental health conditions (that complicate care), or simply the case being considered complex or difficult. It also raises the question of how to address person-specific factors that interfere with care of whatever conditions the patient may have, and invites behavioral health clinicians in medical settings to look beyond care of conditions to the care of persons, and to look beyond disease-specific care management protocols to master generic practices of care management across whatever conditions the person may have. This person-centered emphasis is intrinsic to the concept of the "patient-centered medical home" which has burst into animated discussion and demonstration among providers, health plans, government plans, employer purchasers, and professional associations across public and private entities. This represents an opportunity for collaborative care clinicians to help shape the national state of the art in medical home and includes a range of person-oriented (rather than disease-oriented) practices for care management, including working systematically with complex patients and difficult patient-clinician relationships.
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Stiefel F, Zdrojewski C, Bel Hadj F, Boffa D, Dorogi Y, So A, Ruiz J, de Jonge P. Effects of a multifaceted psychiatric intervention targeted for the complex medically ill: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2008; 77:247-56. [PMID: 18443391 DOI: 10.1159/000129658] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. METHODS Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA(1c) levels (diabetic patients). RESULTS Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). CONCLUSIONS The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
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Affiliation(s)
- F Stiefel
- Service de Psychiatrie de Liaison, University Hospital of Lausanne, Lausanne, Switzerland.
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Kathol RG, Melek S, Bair B, Sargent S. Financing mental health and substance use disorder care within physical health: a look to the future. Psychiatr Clin North Am 2008; 31:11-25. [PMID: 18295035 DOI: 10.1016/j.psc.2007.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After sharing several case examples of health care for patients who have mental health/substance use disorders (MH/SUDs) in the current health care environment, this article describes the advantages that would occur if assessment and treatment of MH/SUDs became a clinical, administrative, and financial part of physical health with common provider networks, the ability to combine service locations (integrated clinics and inpatient units), similar coding and billing procedures, and a single funding pool. Because transition to such a system is complicated, the article then describes several process changes that would be required for integrated service delivery to take place.
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Affiliation(s)
- Roger G Kathol
- Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 194, Suite 14-106 Phillips-Wangensteen Building, Minneapolis, MN 55455, USA.
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Latour CHM, Huyse FJ, de Vos R, Stalman WAB. A method to provide integrated care for complex medically ill patients: The INTERMED. Nurs Health Sci 2007; 9:150-7. [PMID: 17470190 DOI: 10.1111/j.1442-2018.2007.00292.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A growing number of nursing subspecializations have been developed in recent decades. Topics of concern are that care is not tailored to cope with the growing number of patients with more than one chronic disease, there is an increase in co-ordination problems in the care that is provided for this group of complex patients, and the care for these complex patients is extremely fragmented. The assessment of health risks resulting in co-ordinated care with effective communication is vital for multimorbid patients. Our aim is to describe a systematic approach (the INTERMED [IM] method) to identify complex patients who are in need of integrated care and its applicability to the nursing process. We demonstrate the ability of the IM method to quantify, weigh, and classify the complexity of problems. The method is applied in Europe and will be started in the USA in a pharmacy program. The IM is presented as a decision-support system for multidisciplinary teams with nurse co-ordinators.
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Affiliation(s)
- Cornelia H M Latour
- Psychiatric Consultation and Liaison Service, Vrije University Medical Center, The Netherlands
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Latour CHM, Bosmans JE, van Tulder MW, de Vos R, Huyse FJ, de Jonge P, van Gemert LAM, Stalman WAB. Cost-effectiveness of a nurse-led case management intervention in general medical outpatients compared with usual care: an economic evaluation alongside a randomized controlled trial. J Psychosom Res 2007; 62:363-70. [PMID: 17324688 DOI: 10.1016/j.jpsychores.2006.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Revised: 10/23/2006] [Accepted: 10/24/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the cost-effectiveness of a nurse-led, home-based, case-management intervention (NHI) after hospital discharge in addition to usual care. METHODS Economic evaluation alongside a randomized controlled trial after being discharged home with 24 weeks of follow-up. Patients discharged to their home from a general hospital were randomly assigned to NHI or usual care. Clinical outcomes were frequency of emergency readmissions, quality of life, and psychological functioning. Direct costs were measured by means of cost diaries kept by the patients and information obtained from the patients' pharmacists. RESULTS A total of 208 patients were randomized, 61 patients dropped out, and 26 had incomplete data, leaving a total of 121 patients included in the final analysis. There were no statistically significant differences in emergency readmissions, quality of life, and psychological functioning. There was a substantial difference in total costs between the NHI group and the control group (4286 Euro; 95% CI, -41; 8026), but this difference was not statistically significant. CONCLUSION NHI is not a cost-effective intervention. We do not recommend the implementation of this intervention in populations that do not consist of severely vulnerable and complex patients. Future studies should include complexity assessment on inclusion and evaluate the effectiveness and cost-effectiveness of this intervention in patients with more complex profiles.
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Affiliation(s)
- Corine H M Latour
- Psychiatric Consultation and Liaison Service, VU University Medical Center, Amsterdam, The Netherlands.
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