[Referencing and counter-referencing in specialized dental health procedures in Campinas in the state of São Paulo, Brazil]

[Trends in performance indicators and production monitoring in Specialized Dental Clinics in Brazil]

This study aimed to assess time trends in production and performance indicators in secondary dental care services in the Brazilian Unified National Health System (SUS) from 2008 to 2018. A time series study was conducted, based on production data from the Specialized Dental Clinics (CEOs in Portuguese) obtained from the Ambulatory Information System of the SUS. The monitoring indicator was assessed as the proportion of clinics that met the monthly target set for each specialty (primary care, endodontics, surgery, periodontics). Dental services' performance was defined as poor for those that met only one or no targets in the four dental specialties. The time series were analyzed by the decomposition method, considering the components trend, seasonal variation, and random variation. All the analyses were performed for Brazil as a whole and for each of the country's five major geographic regions. A decline was seen in Brazil as a whole in the proportion of clinics that met the primary care targets. There were upward trends in the proportion of compliance with the targets for surgery and periodontics in Brazil as a whole. Important differences were seen between the regions of Brazil in the proportion of compliance with the targets, with the worst performance for the clinics in the North and Northeast regions. Time trends showed an improvement in the services for Brazil as a whole, while emphasizing the importance of assessing the country's regions and the need for constant monitoring of these indicators.

Public oral health services performance in Brazil: Influence of the work process and service structure

The quality of oral health care might be evaluated based on Donabedian’s structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or ≥ the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or ≥ 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA ≥ 1 and 37.05% presenting FDA ≥ the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA ≥ 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA ≥ the mean. OHTs with better structural and work process conditions had better performance.

Evaluation of secondary care in endodontics at a Dental Specialties Center (DSC)

This study aimed to evaluate secondary endodontic care at a Dental Specialties Center (DSC) in Belo Horizonte, MG. Data collection used two forms: (1) on endodontic treatment, completed by the endodontists (2) on the restorative treatment, with data from the medical records. The SPSS 22.0 program was used to analyze the results using frequency and percentiles. In total, 452 endodontic procedures were completed in adult patients. The patients had a median of 39 years of age, most were female (69.7%) and had a primary care referral order (96.2%). Most endodontic treatments were performed in upper premolars (23.7%) followed by lower molars (22.3%), using a mixed technique (74.1%) and in a single session (64.2%). The referral for restorative treatment was for the DSC in 81.2% of cases and finished in 24.1% (n = 109). The counter-referral following restorative treatment occurred in 58.7% of the completed cases. It is necessary to jointly plan the dental treatment between primary and secondary care and, within the latter, among the specialties, in addition to an adequate referral and counter-referral process aimed at ensuring comprehensive care and efficient and effective service.

Fatores associados às faltas em tratamentos ortodônticos em centro de especialidades odontológicas

Resumo O objetivo deste estudo foi identificar os fatores associados ao não comparecimento dos usuários ao tratamento ortodôntico, em três centros de especialidades odontológicas regionais (CEO-R) localizados no estado do Ceará. Metodologia: Os dados foram extraídos de prontuários de pacientes que concluíram o tratamento ortodôntico. Foi calculada a taxa de ausências, com o objetivo de estabelecer um coeficiente de faltas entre os municípios. A fim de descrever o padrão geográfico da ocorrência, foram construídos mapas temáticos baseados nas distribuições. Para as associações entre a variável desfecho (falta ao tratamento) e as independentes (sexo, idade, quebra de aparelho, mudança de profissional, renda e local de residência do usuário), utilizou-se a análise de regressão logística múltipla com p ≤ 0,05. Resultados: Foram examinados 237 prontuários em 20 municípios, com 8.283 consultas ortodônticas realizadas e 2.665 (32,17%) faltas. Apresentou diferença estatisticamente significativa a variável mudança de profissional. Conclusão: O maior número de faltas foi associado à mudança de profissional.

Interface entre a Atenção Primária e a Secundária em odontologia no Sistema Único de Saúde: uma revisão sistemática integrativa

Resumo A atenção secundária em odontologia no Brasil apresenta recursos escassos e em grande parte subutilizados. O desafio consiste em realizar a interface entre a atenção primária à saúde (APS) e a atenção secundária de forma a consolidar o acesso da população à atenção odontológica especializada no Sistema Único de Saúde (SUS). O objetivo deste artigo é analisar publicações nacionais em língua portuguesa e inglesa sobre a interface entre a atenção secundária e a APS em odontologia na perspectiva da integralidade do cuidado no âmbito do SUS. Revisão integrativa considerando as publicações dos seguintes bancos de dados: SciELO (Scientific Eletronic Library Online), Lilacs (Literatura Latino-Americana e do Caribe), Web of Science, Scopus, PubMed (Literatura Internacional em Ciências da Saúde) e Google Acadêmico. Foram encontrados 966 artigos, dos quais 12 foram utilizados na integra. A cobertura das equipes de saúde bucal (ESB) nas estratégias de saúde da família (ESF), a implantação da APS de forma estruturada, o acesso a atenção secundária, o contrarreferenciamento para APS, os indicadores de desenvolvimento e as condições socioeconômicas e desigualdades na distribuição dos CEO’s são fatores que influenciam a integralidade do cuidado em saúde bucal no SUS.

[Reference and counter-reference in oral health: regulation of access to specialized dental care centers]

Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.