"INTERMED": A method to assess health service needs - II. Results on its validity and clinical use

The validity and clinical use of a recently developed instrument to assess health care needs of patients with it physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients' biological, psychological, and social characteristics with information on health care u tilization characteristics. An example of a patient population in which suc h an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically r elevant subgroups in this heterogeneous population can be identified and de scribed based on their INTERMED scores. The INTERMED was utilized in a grou p of patients (N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients unde rwent a medical examination and responded to a battery of validated questio nnaires assessing biological, psychological, and social aspects of their li fe. In addition, the patients mere assessed by the INTERMED. It tons studie d whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores; for this, a hierarchical cluster a nalysis tons performed. In order to clinically describe them, the groups of patients weve compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of pa tients. Comparison with the questionnaires assessing biological, psychologi cal, and social aspects of disease showed that one group can be characteriz ed as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explici tly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports ifs use in clinical practice and its use as a method to describe c ase mix for scientific or health care policy purposes. In addition, the INT ERMED is easy to implement in daily clinical practice and can be of help to ease the operationalization of the biopychosocial model of disease. More i nformation on its validity in different patient populations is necessary. ( C) 1999 Elsevier Science Inc.