Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.

Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.

RESUMOModelo do estudo: Revisão integrativa da literatura. Objetivo: Analisar evidências científicas disponíveis na literatura sobre a utilização do método INTERMED pela equipe multidisciplinar em pacientes com transtornos mentais. Metodologia: A seleção de artigos foi realizada nas bases de dados National Library of Medicine (PubMed), American Psychological Association (PsycINFO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SciELO). Resultados: Ao final, cinco estudos concentrados entre 2000 e 2008, foram selecionados para análise. Os artigos analisados mostraram que o método INTERMED teve resultados positivos na identificação de pacientes que precisam de cuidados complexos, o que direcionou a realização de intervenções psiquiátricas rápidas que diminuíram o tempo de permanência no ambiente hospitalar, o número de internações melhorou a qualidade de vida dos pacientes e, consequentemente, diminuiu custos com a saúde. Conclusão: Os estudos analisados mostraram que há poucas evidências sobre o tema investigado. O método INTERMED tem boa aplicabilidade junto a outros instrumentos e foi eficaz na identificação de pacientes que precisam de cuidados complexos. Palavras-chave: Enfermagem. Enfermagem Psiquiátrica. Saúde Mental. Transtornos Mentais. Integralidade em Saúde. Assistência à Saúde. Avaliação em Enfermagem. Diagnóstico da Situação de Saúde. ABSTRACT Study design: Integrative literature review.

Background: While considerable attention has been devoted to patients health complexity epidemiology, comparatively less attention has been paid to tools to identify and describe, in a personalized and comprehensive way, complex patients in primary health care (PHC). Objective: To evaluate INTERMED tools validity and feasibility to assess health complexity in PHC. Design: Cross-sectional psychometric study. Setting: Three Brazilian PHC Units. Participants: 230 patients above 18 years of both sexes. Measurements: Spearmans rho assessed concurrent validity between the whole INTERMED and their four domains (biological, psychological, social, health system) with other well-validated instruments. Pearsons X2 measured associations of the sum of INTERMED current state items with use of PHC, other health services and medications. Cronbach Alpha assessed internal consistency. INTERMED acceptability was measured through patients views on questions and answers, understanding and application length as well as objective application length. Applicability was measured through patients views on its relevance to describe health aspects essential to care and INTERMEDs items-related information already existing in patients health records. Results: 18.3% of the patients were complex (INTERMED 20/21 cut-off). Spearman correlations located between 0.44 - 0.65. Pearson coefficients found were X2 = 26.812 and X2 = 26.883 (both p = 0.020) and X2 = 28.270 (p = 0.013). Cronbach Alpha was 0.802. All patients views were very favorable. Median application time was 7 minutes and 90% of the INTERMED interviews took up to 14 minutes. Only the biological domain had all its items described in more than 50% of the health records. Limitations: We utilized the cutoff point used in all previous studies, found in research performed in specialized health services. Conclusion: We found good feasibility (acceptability and applicability), and validity measures comparable to those found from specialized health services. Further investigations of INTERMED predictive validity and suitability for routine PHC use are worthwhile.

Introduction: The use of INTERMED in Primary Health Care can contribute to the provision of personalized care plans and integrated care if it shows adequate psychometric properties in that setting. Objectives: The objective of the study was to analyze the validity and applicability of INTERMED in PHC. Methods: The first step of the work consisted of a literature review, in order to analyze its psychometric properties, focusing on patients with mental disorders. The selection of articles was carried out in the databases National Library of Medicine (PubMed), American Psychological Association (PsycINFO), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO). The second stage was the evaluation of its validity and applicability in 230 patients from three PHC services in the city of Ribeirão Preto, using data from interviews and health records. Spearman's correlation coefficients measured the concurrent validity of the scores of each INTERMED domain (biological, psychological, social, health services) with the total score of the Charlson Comorbidity Index, HADS, MOS-SSS and WOQOL-BRE instruments. Pearson's X 2 measured associations of the sum of INTERMED's current state variables with the use of PHC, other health services and medications. Cronbach's alpha assessed internal consistency. We evaluate the applicability of INTERMED through: a) the opinions of patients (the understanding of its questions and answers, relevance to describe aspects of health important for planning care and on the time required for its application); b) the time required for application measured objectively; and c) information about the INTERMED variables already in the patients' medical records. Results: The analyzed articles showed that the INTERMED method had positive results in the identification of patients who need complex care, which directed the performance of rapid psychiatric interventions that decreased the length of stay in the hospital, the number of hospitalizations and improved the quality of patients' life; however, there were no articles regarding its use in PHC. In the second stage, 230 patients completed the assessment (mean age 45.92, 56.1% female). Spearman's correlation coefficients were between 0.44 -0.65. Pearson's coefficients were p = 0.020 (X2 = 26.812 and X2 = 26.883) and p = 0.013 (X2 = 28.270).Cronbach's Alpha was 0.802. More than 93% of patients considered INTERMED to be well understood, with short application time and providing relevant information to help with their care. The average duration of the application was 8.58 minutes. Only the biological domain of INTERMED already had all its variables present in more than 50% of the medical records. Conclusion:INTERMED has good potential for use in the context of PHC and can replace or complement other standardized instruments to assist health professionals and staff. However, further studies are needed, mainly to assess its predictive validity in relation to the use of health services and to assess it...

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