A considerable proportion of patients admitted to a general hospital are complex patients suffering from psychosocial co-morbidities. Epidemiological studies have demonstrated a close relationship between psychosocial co-morbidity, health care utilization and medical and psychological outcomes.
This study evaluates a psychiatric intervention targeted on complex patients identified by means of the INTERMED, a case-finder for case complexity [1,2].
Methods: Complex patients are identified with the INTERMED in a rheumatology inpatient clinic and a diabetes outpatient unit. INTERMED provides a valid and reliable bio-psycho-social assessment [1,2]; patients with cut-off scores >20 being identified as complex [3] are included and randomized into "care as usual" or intervention groups. The intervention consists of (i) a multidisciplinary team conference or (ii) one or more psychiatry and/or liaison nurse consultations. Follow up is scheduled every three months for a year and assesses quality of life, anxiety and depression, medical outcome and health care utilization [4].
Results: After 3 years study period, 893 patients have been approached and 247 patients have been included. After analyses, we can see that major depression reduce from 61% to 28% in the intervention group and remained the stable in care as usual. Compared to care as usual, a significant improvement over time of depressive symptoms was also observed for the intervention group. In addition, hospital admission occurred less often in the latter, reaching statistical significance for the period between 6 and 9 months follow up. The documented baseline and at least follow up levels of HbA1c of only 28 patients did not allow a meaningful statistical analysis.
Discussion: Discussion will focus on a description of the sample, an analysis of correlations between INTERMED scores and the different objective and subjective baseline measures and final results of outcome.