ArticlePloS one2022
Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 27 citations in OpenAlex.
- Clinical Variables Associated with Physician-Driven Inclusion in a Special Management Program for Complex Patients.Journal of clinical medicine · 2025Article
- Validation of the Dermatologic Complexity Score for Dermatologic Triage.Diagnostics (Basel, Switzerland) · 2025Article
- Healthy Lives 5 Axis Scale for individuals with complex health and social needs: assessment of validity and reliability.BMC health services research · 2025Article
- "Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.BMC primary care · 2024Article
- Article
- How family physicians in Singapore recognise complexity during consultations: a qualitative study.BMC primary care · 2024Article
- Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada.BMC health services research · 2023Article
- Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs.Health research policy and systems · 2023Article
- Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review.International journal of environmental research and public health · 2022Article
- Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire.BMC primary care · 2022Article
- Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment.International journal of general medicine · 2022Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundHealth 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.
methodThe 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.
results42 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.
conclusionINTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
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