Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers

Abstract

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.

Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool

“…The 19 items cover four domains (emotional/informational support, instrumental support, positive social interaction, and affection). Items are rated on a 7-point Likert rating scale (1)(2)(3)(4)(5)(6)(7). The overall score is the mean score of all items and ranges from 1 to 7; a higher score indicates a higher level of perceived social support.…”

“…These factors interact dynamically and non-linearly in an idiosyncratic manner for each individual [2][3][4]. The importance of incorporating the assessment of health complexity into the management of PHC patients for delivering high-quality care with desirable outcomes is increasingly recognized worldwide [5][6][7]. This is particularly critical in PHC settings that include one of the most medically and socially vulnerable groups of patients in the world, such as Brazil [5].…”

“…The importance of incorporating the assessment of health complexity into the management of PHC patients for delivering high-quality care with desirable outcomes is increasingly recognized worldwide [5][6][7]. This is particularly critical in PHC settings that include one of the most medically and socially vulnerable groups of patients in the world, such as Brazil [5]. Despite this acknowledgement, healthcare complexity assessment has been suboptimal or has not been integrated into PHC practice at all, partially because efficient methods for its evaluation in adult PHC are still lacking [8].…”

É viável a gestão de casos na Atenção Primária no Brasil para pacientes com multimorbidades? Análise secundária de estudo qualitativo com pacientes e profissionais de unidades de Estratégia de Saúde da Família no XIII Departamento Regional de Saúde do estado de São Paulo

“…Nesse caso, tanto a escolha quanto a adesão ao tratamento podem ser mais difíceis e a não adesão pode reduzir ainda mais a qualidade de vida que já é baixa (Kathol et al, 2018); Os cuidados para pessoas com doenças crônicas, particularmente para aquelas com MM, requerem consideração cuidadosa, pois são padrões individuais complexos de cuidados (Navickas et al, 2016, Kathol et al, 2018e Schaink et al,2012. Um estudo qualitativo recente na atenção primária brasileira, mostrou o uso do gerenciamento de MM na atenção primária experimentada por pacientes e profissionais de saúde (Rzewuska et al, 2021).…”