A complexidade das necessidades de saúde na atenção básica avaliada pelo INTERMED

Abstract

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...