Associated factors of prosthetic rehabilitation in specialized dental care in Brazil: a cross-sectional study

OBJECTIVE

This study aimed to analyze the individual and contextual factors associated with prosthetic rehabilitation in Dental Specialty Centers (DSC) in Brazil. A cross-sectional study, with secondary data from modules II and III of the External Assessment of the 2nd Cycle of the National Program for the Improvement of Access and Quality (PMAQ) of DSCs, was conducted in 2018. Individual variables considered were socioeconomic conditions and perceptions about the structure and service of the DSC. Contextual variables were related to DSC. We considered the region of the country (capital or countryside), geographic location and work process of the DSC for prosthetic rehabilitation. The association between individual and contextual variables and prosthetic rehabilitation in the DSC was analyzed by multilevel logistic regression.

RESULTS

Ten thousand three hundred ninety-one users from 1,042 DSC participated. Of these, 24.4% used dental prosthesis and 26.0% performed at the DSC. In the final analysis, performed dental prostheses in the DSC individuals with less education (OR = 1.23; CI95%:1.01-1.50) and residents of the same city as the DSC (OR = 1.69; CI95%:1.07-2.66), at a contextual level, DSCs of the countryside (OR = 1.41; CI95%:1.01-1.97) were associated with the outcome. Individual and contextual factors were associated with prosthetic rehabilitation in the DSC.

Contextual and local determinants associated with the achievement of goals in the endodontics specialty in Brazilian dental speciality centres: A multilevel analysis

OBJECTIVES

To assess which factors were associated with the achievement of endodontic goals.

METHODS

Cross-sectional study using secondary data from the second cycle of the Program for the Improvement of Access and Quality in the dental speciality centres-in Portuguese PMAQ-CEO. The independent variables extracted from this database were related to dental speciality centres (CEO in Portuguese). In addition, variables referring to the CEO host city were incorporated into the model. The outcome variable was the number of endodontic goals achieved calculated from the production of the CEO available in the Ambulatory Health Information System in 2018. Descriptive analyses and multilevel Poisson regression were performed with the software SPSS 23.0 and STATA 14.0.

RESULTS

CEOs with more than 20% of patients' absenteeism were 26% less likely to reach the goals of the endodontics specialty; CEOs with availability of endodontists for more than 40 hours a week were two times more likely to reach the goals than those with less than 40 hours in endodontics specialty. CEOs with a waiting time for endodontic procedures greater than 45 days achieved a number of goals 31% lower than those with a waiting time up to 45 days. CEO type I and CEO type II showed 2.10 and 1.20 higher likelihood to reach the number of goals of the endodontics specialty than CEO type III. The number of endodontic instruments in sufficient number was positively associated with the achievement of goals. CEOs located in municipalities that reached more than 5% in the supervised brushing indicator had 2.26 greater likelihood to achieve the goals than those that did not reach this percentage.

CONCLUSION

Contextual and local determinants are associated with the achievement of goals in the endodontic specialty in the dental speciality centres in Brazil.

Brazilian Oral Health Policy: metasynthesis of studies on the Oral Health Network

OBJECTIVE

Analyze the performance of the oriented oral health care network from its implementation, in 2004 to 2020, according to publications on the subject.

METHODS

This is a research with a methodological description of metasynthesis.

RESULTS

The searches resulted in 600 complete publications (586 in the first search and another 14 in the second search), according to the established criteria. 539 articles were excluded: 151 after duplication analysis, 236 after reading the title, 45 by type of publication and 107 after reading the abstract, as they did not fit the research theme. Thus, 61 original publications and another 29 publications in snowball sampling were selected and analyzed, totaling 90 publications. From this selection, we chose to use the model proposed by the Projeto de Avaliações de Desempenho de Sistemas de Saúde (PROADESS - Health Systems Performance Assessment Project). The study will use its guiding principles on the dimension "Health Services Performance".

CONCLUSION

The analyzed set allowed us to identify that the way the Brazilian State organizes and finances oral health care made it possible to expand access and the number of procedures performed, but not the creation of an effective comprehensive care network, after more than a decade of implementation of Brasil Sorridente (Smiling Brazil).

[Dental imaging procedures in the Unified Health System and the expansion of secondary care: series between 2000-2016]

The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.

Satisfação das gestantes durante a consulta odontológica no Sistema Único de Saúde, Brasil

Objetivo O objetivo do trabalho foi verificar a taxa de gestantes satisfeitas com a consulta odontológica realizada no Sistema Único de Saúde (SUS-Brasil) e fatores associados. Metodologia O estudo foi do tipo transversal. Para coleta de dados foi elaborado um questionário abordando variáveis sociodemográficas e relacionadas a gestação. A coleta de dados foi realizada através de entrevistas face a face em um hospital maternidade da região metropolitana de Porto Alegre-RS-Brasil. O teste de qui-quadrado e a regressão de Poisson com variância robusta (p<0,05) foram utilizados nas análises bi e multivariada. Resultados Das 302 mulheres entrevistadas, 50%(n=151) realizaram consulta odon- tológica durante a gestação e destas, 86% (n=131) estavam satisfeitas com a consulta. Na análise multivariada verificou-se que a variável avaliação das consultas de pré-natal como boa aumentou em 14% [Razão de Prevalência (RP)=1,14; Intervalo de Confiança (IC) 95%:1,01-1,27] a probabilidade de as mulheres expressarem satisfação com a variável desfecho. Conclusão Conclui-se que foi alta taxa de satisfação com as consultas odontológicas realizadas no SUS pelas gestantes e avaliação das consultas de pré-natal como boa foi fator associado. Estes resultados poderiam ser considerados durante o planejamento estratégico, execução e avaliação das políticas de saúde direcionadas para este grupo operativo.