The INTERMED: a screening instrument to identify multiple sclerosis patients in need of multidisciplinary treatment

Abstract

Objective: To analyse the value of the INTERMED, a screening instrument to assess case complexity, compared with the Expanded Disability Status Scale (EDSS) and the Guy's Neurological Disability Scale (GNDS) to identify multiple sclerosis (MS) patients in need of multidisciplinary treatment. Methods: One hundred MS patients underwent INTERMED, EDSS, and GNDS examinations. Patient care needs were assessed by a multidisciplinary team and a goal oriented treatment plan was defined. Correlations between INTERMED, individual INTERMED domains, EDSS, GNDS sum score, and total number of proposed disciplines involved in the treatment plan were studied. Results: Mean (SD) age was 40.6 (10.1) years. Median scores were 14.0 for the INTERMED, 4.0 for the EDSS, and 13.5 for the GNDS sum score. Moderate correlations were found between the INTERMED sum score and EDSS (r=0.59) and GNDS sum score (r=0.60). The number of disciplines as proposed by the multidisciplinary team showed the highest statistically significant correlation with the INTERMED sum score (r=0.41) compared with EDSS (r=0.32) and GNDS sum score (r=0.34). No significant or only weak correlations were found between the psychological domain of the INTERMED and EDSS or GNDS. Conclusion: The findings in this study show that there is an additional value of the INTERMED compared with the EDSS and GNDS in identifying MS patients in need of multidisciplinary treatment. The INTERMED domains show the area of the patient's vulnerability and care needs: especially the INTERMED's psychological and social domains may guide the clinician to deal with specific problems that complicate healthcare delivery.

Operationalization of Biopsychosocial Case Complexity in General Health Care: The INTERMED Project

“…In a sample of patients under dialysis, we found that IN-TERMED scores were associated with low quality of life at 1-year follow-up [24], which in turn was unrelated to baseline parameters of the severity of illness. In multiple sclerosis outpatients, INTERMED scores were associated with measures of disability and with the number of disciplines proposed in the multidisciplinary treatment plan [25]. These data confirm the ability of the INTERMED to detect patients at risk and to predict clinical outcomes in several patient samples.…”

Biopsychosocial Health Care Needs at the Emergency Room: Challenge of Complexity

“…As measured by the INTERMED method, complexity indicates a need for multidisciplinary and integrated treatment. This has been demonstrated for different patient groups [1]–[5]. Compelling evidence suggests that biopsychosocial case complexity influences patient health outcomes [6], [7], health care use [8], patient management [9], [10] and health care expenditure [11].…”

Outcomes of a Rheumatoid Arthritis Disease Therapy Management Program Focusing on Medication Adherence

“…During the initial consultation (month 0), clinicians used the INTERMED, a validated observer-rated instrument for assessing case complexity and health care needs using a biopsychosocial model, [11][12][13][14][15][16][17][18] to stratify patients into either the regular-intensity (score of 0 through 20) or high-intensity (score of 21 or more) program. For the regular-intensity program, consultations were conducted intermittently at enrollment (month 0) and months 1, 4, and 6.…”