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Assessing Health Care Needs and Clinical Outcome With Urological Case Complexity: A Study Using INTERMED

Received Feb. 7, 2002; revision received Aug. 6, 2002; accepted Sept. 11, 2002. From the Department of Medical Psychology and Psychotherapy and the Department of Urology, University Hospital, Innsbruck, Austria; and the Department of Social Psychiatry, University of Groningen, Groningen, the Netherlands. Address reprint requests to Dr. Di Gangi-Herms, Institut für Medizinische Psychologie und Verhaltensneurobiologie, Gartenstrasse 29, D-72074 Tübingen, Germany; alida.digangi{at}med.uni-tuebingen.de (e-mail).

Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an instrument for assessing case complexity and health care needs, was able to identify such complex cases, to estimate the amount of comorbidity, and to predict clinical outcome for 31 consecutive patients suffering from urinary tract symptoms. To assess clinical outcome, the authors used the American Urologic Association Symptom Score, the Brief Symptom Inventory, and the Hospital Anxiety and Depression Scale. On the basis of the patients' INTERMED scores, the authors distinguished between low-complexity patients (INTERMED score <21, N=25, 80.6%) and high-complexity patients (INTERMED score 21, N=6; 19.4%). Low-complexity patients had fewer depressive and anxiety symptoms, less distress, and better clinical outcome at their 3-month follow-up than high-complexity patients. The data confirmed the ability of the instrument to detect patients at risk of complex urinary tract symptoms and to predict clinical outcome.

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