ObjectivePrimary aim; to determine the feasibility of implementation of the INTERMED Self-Assessment (IM-SA) in adult patients scheduled for total knee arthroplasty (TKA). Secondary aim; to measure biopsychosocial complexity, referral to psychiatry or psychology in cases of complexity and to gain insight into the relation between biopsychosocial complexity and length of stay (LOS), method of discharge (MOD) and polypharmacy.MethodsA feasibility study was conducted with 76 participants in a general hospital in the Netherlands. Feasibility was determined by the number of completed questionnaires, time spent completing the questionnaire and the attitude of staff and patients towards the IM-SA.A cut off point ≥19 on the IM-SA was used to determine the prevalence of biopsychosocial complexity. A case file study was performed to check if referral to psychiatry or psychology had taken place.The Spearman's Rank Correlation Coefficient or Phi was used to determine if there was a relation between biopsychosocial complexity and LOS, MOD and polypharmacy.ResultsAll participants completed the IM-SA. The average time spent completing the questionnaire was 11.46 min (SD 5.74). The attitude towards the IM-SA was positive.The prevalence of biopsychosocial complexity was 11.84%. Referral to psychiatry or psychology did not take place.There was no relation between complexity and LOS (Spearman's rho (r) = 0.079, p = 0.499, MOD (Phi = 0.169, p = 0.173) and polypharmacy (Phi = 0.007, p = 0.953).ConclusionBiopsychosocial complexity can be identified in TKA patients during the pre-operative phase by using the IM-SA. Implementation of the IM-SA in a Dutch general hospital is feasible.
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OBJECTIVES: 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 in- and outpatients, and its predictive value for health care utilization (HCU) and quality of life (QoL).METHODS: 850 participants aged 17 to 90 from 5 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's alpha; interrater agreement by intraclass correlation coefficients (ICCs); convergent validity of IMSA scores with mental health (SF-36 emotional well-being subscale and HADS), medical health (CIRS) and QoL (EQ-5D) by Spearmans rank correlations; predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models.RESULTS: Feasibility, face validity and reliability (Cronbach's alpha 0.80) were satisfactory. ICC between IMSA and IM total scores was .78 (95% CI .75-.81). Correlations of the IMSA with the SF-36, HADS, CIRS and EQ-5D (convergent validity) were -.65, .15, .28 and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency room visits, hospitalization, outpatient visits, and diagnostic exams) after 3 and 6 months follow-up. Results were comparable between hospital sites, in- and outpatients, and age groups.CONCLUSION: 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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Background: There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. Objective: The aim of this study was to contribute to an understanding of the complexity of selfmanagement goal setting in primary care by exploring experts’ and primary care professionals’ experiences with self-management goal setting and viewpoints regarding influencing factors. Methods: A descriptive qualitative research methodology was adopted. Two focus groups and three individual interviews were conducted (total participants n = 17). Thematic content analysis was used to analyse the data. Results: The findings were categorized into four main themes with subordinated subthemes. The themes focus around the complexity of setting non-medical goals and around professionals’ skills and attitudes to negotiate and decide about goals with patients. Furthermore, patients’ skills and attitudes for goal setting and the integration of goal setting in the time available were formulated as themes. Conclusions: Setting self-management goals in primary care, especially in family medicine, might require a shift from a medical perspective to a biopsychosocial perspective, with an increasing role set aside for the professional to coach the patient in expressing his self-management goals and to take responsibility for these goals.
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