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Introduction: The INTERMED method was created to identify patients with multiple care risks, needs and negative health outcomes, in order to assess their biopsychosocial complexity as a first step towards integrated care. Until now, it was based on a face-to-face interview (IM-CAG). Several studies in the last decades have confirmed its face-validity and reliability. A self-assessment version was derived (IM-SA) providing a complementary tool for clinical and research applications. Aim: Preliminary evaluation of IM-SA''s predictive validity, in comparison to IM-CAG''s. Methods: 29 outpatients with liver disorders referred to the consultation-liaison psychiatry service of the Modena University Hospital underwent the protocol of evaluation, including: IM-SA, IM-CAG, CIRS, HADS, SF-36, EuroQol. Clinical and socio-demographic data were also collected for all patients. Results: Both INTERMED instruments, IM-CAG and IM-SA, were able to identify complex patients (with a total score higher than 21/60) and showed similar correlations to the other measurements (with a mean difference between correlations of 24%). Discrepancies were also suggested by preliminary data, particularly related to the prognostic assessment (“vulnerability”). Conclusion: Preliminary results suggest that IM-SA is able to predict complexity of health care needs. The IM-SA Study, an European multicentric project supported by the INTERMED Foundation and including different clinical populations, will provide stronger evidence about generalizability of data. [Copyright &y& Elsevier]

Consultation-liaison (C-L) psychiatry has an important role in the management of somatoform disorders (SD). Characteristics of SD patients in C-L psychiatry are largely unknown and are presented in this paper. We analyzed 13,314 Dutch psychiatric consultations from 1984 to 1991 and compared patients diagnosed with SD to patients with other mental disorders and to those without a mental disorder. The comparison included socio-demographic variables, consult characteristics, medical history, current somatic morbidity, information about additional diagnostic tests, hospital admission time and aftercare management. Of the 544 SD patients 39.5% (n = 215) were diagnosed with a conversion disorder that illustrates the highly selected nature of SD patients in C-L psychiatry. Employment among SD patients decreased significantly from 58% in the group aged 20–29 years to 6% in the group aged 50–59 years. This decrease was significantly larger as compared to other mental disorders and no mental disorders and was virtually unaffected by correction for potential confounding by gender. Contrary to our expectation no difference between the three groups was observed in claims for disability benefits. Of the SD patients 74.5% were referred for aftercare management, significantly more than the other two groups which is considered a promising development in C-L psychiatry. [Copyright &y& Elsevier]

Objectives: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs/risks of patients. It consists of a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to assess preliminary the effectiveness of a training program on the clinical use of INTERMED. Methods: After a group training on the use of INTERMED carried out between April and September 2009, the method was applied to 30 female patients aged between 20 and 65, subsequently referring to three clinical settings: a GP clinic; a psychiatry day-care clinic; a CLP out-patient clinic. Demographic and clinical data were collected, together with administration of HADS and WHOQoL-bref. Results: The mean INTERMED score was 20.8, borderline as to definition of complex cases. Patients from the GP clinic and in the CLP setting scored lower (respectively 16.5 and 18.2) than patients from the psychiatric day-clinic (27.8), suggesting that the presence of severe psychiatric disturbances might contribute to increasing the level of case-complexity. Concordance with results at HADS and WHOQoL was high. Conclusions: A clinical practice in the use of INTERMED after the theoretical phase of the training process is necessary to reinforce effectiveness of the training. These preliminary positive results will hopefully open the way to a wider diffusion of this tool in clinical practice in the area of Modena. [Copyright &y& Elsevier]

Objectives: INTERMED is an instrument to assess bio-psycho-social case complexity in general health care by focusing on past, present and future health needs and risks of patients. It consists in a structured interview defining 20 variables and related anchor points. The total score ranges from 0 to 60, reflecting the level of complexity and the related care needs/risks. The aim of this work was to describe the training process on the use of INTERMED and to assess its effectiveness. Methods: A training group of 9 subjects had two-hour meetings twice a month between April and September 2009. After introductory sessions on theoretical aspects and inter-trainee simulations on interviewing and scoring techniques, students were assigned the task of producing video-recorded clinical material, which was used to comment on interviewing skills and practice on scoring. Individual and consensus scores were collected at the beginning and at the end of the training and compared statistically by means of Cohen''s kappa. Results: Motivation and involvement of students in the training was high (participation was on a voluntary basis during extra-work hours), as satisfaction. Agreement between individual and consensus scores was high already at the beginning of the training (Cohen''s kappa mean value of 0.80) and slightly improved during the course. Conclusions: The training process gave positive results both on the quantitative and the qualitative sides of evaluation. A six-month 25-hour training period is a reasonable time for learning how to master the instrument, although it needs to be followed by the clinical practice. [Copyright &y& Elsevier]