Abstract
Introduction:This project presents an interprofessional intervention between medicine and psychology in a teaching outpatient clinic linked to the SUS (Sistema Único de Saúde), Brazil’s unified health system, in Curitiba, South of Brazil. Focusing on brief psychological screening and coordination between levels of health care, the initiative aims to increase treatment adherence and improve clinical outcomes, in line with UN SDGs 3 and 10.
Problem: Health professionals face difficulties in managing patients with complex psychological disorders, which affects treatment adherence and clinical results. Traditional medical training does not fully prepare professionals to identify and deal with these disorders, especially in complex contexts, which can directly impact understanding and adherence to medical guidelines. Interprofessionality in the SUS emerges as a strategy to integrate mental and physical health, providing collaborative and comprehensive care.
Context: Patients in highly complex services often have a low understanding of therapeutic guidelines due to factors such as low education and mental disorders. In socioeconomically vulnerable regions, the fragmentation between mental and physical health is accentuated, limiting the effectiveness of care provided by PHC (Primary Health Care) and the SUS. This pilot project, implemented by a higher education institution in the metropolitan region of Curitiba, integrates medical and psychology students to strengthen the connection between mental and physical health.
Intervention: A field for psychological analysis was proposed to the electronic medical records, where medical and psychology students could categorize patients as adaptive or maladaptive in their coping with the disease. The psychology team prepares an analysis of the mental and emotional needs that interfere with adherence to treatment, such as perceptual, psychiatric and social barriers. Complex cases are identified and referred for follow-up in PHC, with a counter-referral flow to ensure continuous care.
Target Population: The intervention covers patients in medical specialties treated in the outpatient clinic, predominantly people with low levels of education, informal workers, retirees and Venezuelan immigrants. The socioeconomic profile and comorbidities of these patients require special attention to understand medical guidelines, a challenge addressed by the integration between medical and psychology students.
Engagement: The medical and psychology students involved showed interest in interprofessional practices, being trained in communication and decision-making in a collaborative environment. Also engaged outpatients with diagnosed psychiatric diseases or non-diagnosed but in mental suffering. Debriefing sessions were held between preceptors and students to adapt the approaches to the identified needs.
Co-Design: From the conception, academics participated in the creation and adaptation of the project, developing triage and integration protocols between the areas of psychology and medicine. Continuous feedback allowed for adjustments to the flow of care and implementation of integration tools in the electronic medical record.
Results and Impacts: The intervention improved interprofessional communication and generated a standardized flow for recording psychological information in the medical record, facilitating coordination between levels of care and meeting the mental health needs of patients in a comprehensive manner. The counter-referral system for PHC ensured continuous monitoring of patients with psychiatric demands, contributing to SDG 3 (health and well-being) and SDG 10 (reduction of inequalities).