基层医疗中的健康复杂性评估：INTERMED 工具的有效性和可行性研究。
Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool.
机构信息
Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Registered Nurse, Hospital do Coração (HCor), São Paulo City, Brazil.
出版信息
PLoS One. 2022 Feb 18;17(2):e0263702. doi: 10.1371/journal.pone.0263702. eCollection 2022.
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.
背景
健康复杂性包括生物、心理、社会和医疗系统。具有复杂的健康需求与较差的临床结果和更高的医疗保健成本相关。在初级保健（PHC）中，越来越多地推荐对健康复杂的人进行护理管理。INTERMED 复杂性评估网格在专业环境中表现出了足够的心理测量学特性。本研究旨在评估 INTERMED 在评估成人 PHC 人群健康复杂性方面的有效性和可行性。
方法
使用 INTERMED 访谈对来自巴西三个 PHC 服务的 230 名连续成年患者的生物心理社会健康需求进行评估。总分>20 的参与者被归类为“复杂”。使用世界卫生组织生活质量简表（WHOQOL-BREF）测量生活质量；使用医院焦虑抑郁量表（HADS）测量焦虑和抑郁症状；使用医疗结局研究社会支持量表（MOS-SSS）测量社会支持；使用 Charlson 合并症指数（CCI）测量合并症水平。我们开发了两个问卷来评估卫生服务的使用情况，以及患者对 INTERMED 的感知可行性。
结果
42 名参与者（18.3%）被归类为“复杂”。INTERMED 总分与 WHOQOL-BREF 总分（rho=-0.59）和 HADS 总分（rho=-0.56）之间存在中度相关性，与 INTERMED 的社会领域与 MOS-SSS 之间也存在中度相关性（rho=-0.44）。调整后，使用 PHC（β=2.12，t=2.10，p<0.05）、任何其他医疗保健服务（β=3.05，t=3.97，p<0.01）和任何药物（β=3.64，t=4.16，p<0.01）与更高的 INTERMED 得分相关。INTERMED 的内部一致性较好（ω=0.83），应用时间中位数为 7 分钟。患者对问题、答案和应用时间表示满意。
结论
INTERMED 在 PHC 人群中表现出良好的心理测量学价值，并在 PHC 中具有实际应用的潜力。
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