Reflections and perspectives

Complex patients who have biopsychosocial comorbidities represent a major challenge for the current health care system. Unlike standard medical situations for which medical care can be based on an evidence-based approach, complex patients require a broader concept of care. As demonstrated throughout this issue, such an integrated approach that takes into account the concepts of case- and care complexity is not only possible, it is cost-effective. Integrated care, however, needs assessment tools and a communications-based approach that fosters exchange and collaboration between different medical disciplines and professions and patients

Identifiers, or "Red Flags," of complexity and need for integrated care

Because complex medical patients are a subgroup of the medical population and because complexity assessment involves extra effort, preselection of these patients through identifiers is necessary. There is no best identifier for complexity, and the one most suitable for the population served should he selected. This article provides a table with poten\uf1al identifiers and discurses the difference between disease-oriented screening and treatment and a more generic approach such as complexity screening and complexity management

Integrated care for the complex medically ill

[Contents] P. 533-548: Assessing the effectiveness of integrated interventions: terminology and approach / Graeme Smith and David Clarke. P. 549-572: Epidemiologic trends and costs of fragmentation / Roger Kathol et al. P. 573-591: The metabolic syndrome, depression and cardiovascular disease : interrelated conditions that share pathophysiologic mechanisms / Rijk O.B. Gans. P. 593-601: Vulnerability in the elderly : frailty / Joris P.J. Slaets. P. 603-626: Symptoms, syndromes, and the value of psychiatric diagnosis in patients who have functional somatic disorders / Kurt Kroenke and Judith G.M. Rosmalen. P. 627-646: Disease-focused or integrated treatment : diabetes and depression / Leonard E. Egede. P. 647-677: Models of integrated care / Lawson R. Wulsin, Wolfgang Söllner, and Harold Alan Pincus. P. 679-692: Case and care complexity in the mentally ill / Peter de Jonge, Frits J. Huyse and Friedrich C. Stiefel. P. 693-701: The complexity of communication in an environment with multiple disciplines and professionals : communimetrics and decision support. P. 703-712: Identifiers, or "Red flags," of complexity and need for integrated care / Fritz J. Huyse, Friedrich C. Stiefel and Peter de Jonge. P. 713-758: Operationalizing integrated care on a clinical level : the INTERMED Project / Friedrich C. Stiefel, et al. P. 759-760: Reflections and perspectives / Friedrich C. Stiefel and Frits J. Huyse

Reflections and perspectives

Complex patients who have biopsychosocial comorbidities represent a major challenge for the current health care system. Unlike standard medical situations for which medical care can be based on an evidence-based approach, complex patients require a broader concept of care. As demonstrated throughout this issue, such an integrated approach that takes into account the concepts of case- and care complexity is not only possible, it is cost-effective. Integrated care, however, needs assessment tools and a communications-based approach that fosters exchange and collaboration between different medical disciplines and professions and patient

Identifiers, or "Red flags," of complexity and need for integrated care

Because complex medical patients are a subgroup of the medical population and because complexity assessment involves extra effort, preselection of these patients through identifiers is necessary. There is no best identifier for complexity, and the one most suitable for the population served should be selected. This article provides a table with potential identifiers and discusses the difference between disease-oriented screening and treatment and a more generic approach such as complexity screening and complexity managemen

Case and care complexity in the medically ill

The concept of complexity is described increasingly in the medical literature and refers to the care needs of patients who have multimorbid conditions and the organizational structure of health care systems. This article provides an overview of the literature on this concept and discusses the need to reconcile case and care complexity. Case complexity has been operationalized in several ways. Conversely, the operationalization of care complexity has drawn much less attention. As an example, an empiric model to describe the interrelations of several indicators of care complexity is presente

The applicability of antidepressants in the depressed medically ill: an open clinical trial with fluoxetine

In the literature the side-effects and medical complications of tricyclic antidepressants (TCAs), in the medically ill have been extensively reviewed. This study uses a prospective design to examine these issues' questions in an almost solely in-patient C-L population (N=37) treated with a serotinergic antidepressant (fluoxetine). A first remarkable finding is the fact that 83% of the patients have complaints comparable with the side-effects of the drug, prior to its administration. Second, although the drop-out rates (DO) are comparable with those in earlier studies, in this study DO do not seem to be related to the seriousness of the side-effects of the drug. The more serious side-effects were hyponatremia (N=1) and gastrointestinal symptoms (N=3). In contrast to TCAs no psychiatric side-effects have to be reported. Therefore this study suggests that with good medical supervision fluoxetine can be used in the treatment of seriously medically ill patients with depressive co-morbidity