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Goñi-Navarro A, Mollá-Roig P, de la Fuente-Meira S, Campos Ródenas R. [Translated article] Biopsychosocial Complexity in Patients With Hidradenitis Suppurativa: A Pilot Study of a Psychodermatology Assessment Scale. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T271-T273. [PMID: 36690148 DOI: 10.1016/j.ad.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/31/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
- A Goñi-Navarro
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - P Mollá-Roig
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S de la Fuente-Meira
- Servicio de Dermatología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - R Campos Ródenas
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Biopsychosocial Complexity in Patients With Hidradenitis Suppurativa: A Pilot Study of a Psychodermatology Assessment Scale. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:271-273. [PMID: 35963338 DOI: 10.1016/j.ad.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
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Robbins-Welty GA, Gagliardi JP. Integrated Care for Complicated Patients: A Role for Combined Training and Practice. Am J Geriatr Psychiatry 2023; 31:222-231. [PMID: 36437177 DOI: 10.1016/j.jagp.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Patients with chronic medical disease frequently have comorbid psychiatric illness, yet mental and physical healthcare is frequently siloed in the United States. Integrated behavioral healthcare models, such as medicine-psychiatry services, are feasible, improve patient outcomes, and reduce costs. The Duke University Hospital medicine-psychiatry service provides holistic patient care and serves as a model for those interested in developing combined services or training programs elsewhere. Combined residency training in psychiatry is a way to provide a workforce of physician-scientist educators adept at providing coordinated, integrated care for complex patients with comorbid illness.
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Affiliation(s)
- Gregg A Robbins-Welty
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC.
| | - Jane P Gagliardi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC
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Kaneko H, Hanamoto A, Yamamoto-Kataoka S, Kataoka Y, Aoki T, Shirai K, Iso H. Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16113. [PMID: 36498188 PMCID: PMC9741446 DOI: 10.3390/ijerph192316113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.
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Affiliation(s)
- Hiromitsu Kaneko
- Faculty of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | | | - Sachiko Yamamoto-Kataoka
- Department of Health Informatics, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Kyoto 606-8226, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Kyoto 606-8501, Japan
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Maunder RG, Wiesenfeld L, Lawson A, Hunter JJ. The Relationship Between Childhood Adversity and Other Aspects of Clinical Complexity in Psychiatric Outpatients. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:9060-9076. [PMID: 31339443 DOI: 10.1177/0886260519865968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presentations that require more intensive treatment. We examined the relationship between childhood adversity and other contributors to clinical complexity in adult outpatients seeking mental health assessment. In a cross-sectional study, patients completed standard measures of psychological distress and functional impairment. Psychiatrists completed an inventory of clinical complexity, which included childhood abuse, neglect, and loss. Of 4,903 patients seen over 15 months, 1,315 (27%) both consented to research and had the measure of complexity completed. Childhood abuse or neglect was identified in 474 (36.0%) and significant childhood loss in 236 (17.9%). Correcting for multiple comparisons and controlling for psychiatric diagnosis, age, and sex, patients with childhood abuse or neglect were significantly more likely to also have 11 of 31 other indices of clinical complexity, with odds ratios ranging from 1.7 to 5.0. Both childhood abuse or neglect and childhood loss were associated with greater overall complexity (i.e., more indices of complexity, χ2 = 136 and 38 respectively, each p < .001). Childhood abuse and neglect (but not childhood loss) were significantly associated with psychological distress (Kessler Psychological Distress Scale [K10] score, F = 6.2, p = .01) and disability (World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] score, F = 5.0, p = .03). Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments. Identifying childhood adversity as a common antecedent of complexity may facilitate developing transdiagnostic programs that specifically target sources of complexity.
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Affiliation(s)
- Robert G Maunder
- University of Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Lesley Wiesenfeld
- University of Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Andrea Lawson
- University of Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Jonathan J Hunter
- University of Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
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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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Silva HSD, Gutierrez BAO. Care complexity in hospitalized elderly according to cognitive performance. Rev Bras Enferm 2019; 72:134-139. [PMID: 31826202 DOI: 10.1590/0034-7167-2018-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline. METHOD quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP. RESULTS cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain. CONCLUSION the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.
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Click B, Regueiro M. The Inflammatory Bowel Disease Medical Home: From Patients to Populations. Inflamm Bowel Dis 2019; 25:1881-1885. [PMID: 30934057 DOI: 10.1093/ibd/izz062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 12/14/2022]
Abstract
With increasing emphasis on cost reduction and quality improvement, the transition to value-based care is underway. New models of health care delivery are being explored to optimize patient experience and outcomes while decreasing health care expenses. One such model is the specialty medical home (SMH), which provides multidisciplinary, high-quality care for chronic diseases with specialist involvement, such as inflammatory bowel disease (IBD). This review aims to explore the rationale behind initial construction, the critical personnel and components, the early outcomes of established models, comparison with other value-based care models, and the role of an IBD SMH in population health management.
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Affiliation(s)
- Benjamin Click
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
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Gutierrez BAO, Silva HSD, Chubaci RYS, Borja-Oliveira CR. Complexity of care of hospitalized older adults and its relationship with sociodemographic characteristics and functional independence. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objectives: To investigate the relationship between the complexity of care of hospitalized older adults and sociodemographic and functional independence characteristics. Method: A quantitative cross-sectional and descriptive study was carried out in the medical and surgical clinics of the University Hospital of the Universidade de São Paulo, in the state of São Paulo SP, Brazil. A total of 382 older adults were assessed through a socio-demographic inventory, the Mini Mental State Exam, the Katz Index of Independence in Activities of Daily Living and the Interdisciplinary Medicine Instrument Method. Results: The complexity of care of participants was associated with the female sex (p=0.003), not having a partner (p=0.003), having a lower income (p=0.022), cognitive decline (p<0.001) and dependence in basic activities of daily living (BADL) (p<0.001). In the multiple logistic regression model, variables such as the female sex (OR=1.76; p=0.018), dependence in one or more activities of daily living (OR=1.26; p<0.001) and cognitive decline (OR=3.31; p<0.001) remained associated with complexity of care. Conclusion: The complexity of care of hospitalized older adults, as it is associated with limitations in BADL and cognitive decline, requires actions by the interprofessional team to ensure the rehabilitation, integration of long-term care and planning of care resources for older patients. Thus, it is necessary to adopt integrated services that include home care and care networks for the elderly, in order to provide qualified post-hospital discharge care and promote the health of the hospitalized older population.
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Regueiro M, Click B, Holder D, Shrank W, McAnallen S, Szigethy E. Constructing an Inflammatory Bowel Disease Patient-Centered Medical Home. Clin Gastroenterol Hepatol 2017. [PMID: 28624253 DOI: 10.1016/j.cgh.2017.05.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Miguel Regueiro
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Benjamin Click
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane Holder
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William Shrank
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandra McAnallen
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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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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