User satisfaction with the secondary dental care services: Is there an association between structure and work process?

OBJECTIVE

To assess the association between user satisfaction in relation to secondary dental care services and the structure and process of Brazilian Dental Specialty Centers (CEO, in Portuguese).

METHODS

This study used nationwide secondary data from two CEO evaluation cycles. Ten users from each CEO answered questions on the self-perception of healthcare quality and satisfaction with health services. Latent class analysis (LCA) was performed to identify subgroups of satisfied and dissatisfied users (outcome). The CEO structure included equipment, supplies, instruments, ambience and type of CEO (type I, II or III, according to the number of dental chairs and dental professionals). The work process referred to the planning/monitoring of actions, collaborative care, characteristics of the demand for medical care /the organization of scheduling, and continuing education for employees. Covariables concerned user profiles. A multilevel logistic regression model was used (p-value <.05).

RESULTS

Seven thousand nine hundred and ninety-seven users in 794 CEOs, together with 10056 users in 911 CEOs, participated in the 1st and 2nd evaluation cycles, and satisfied users corresponded to 85.3% and 87.1%, respectively. In both cycles, the CEO's structural characteristics explained most of the variance in satisfaction. CEOs with more favourable structural characteristics showed higher satisfaction. Users from CEOs, type II and III, and those who received dental care where there was an interruption of services due to a lack of equipment or instruments reported a lower level of satisfaction. CEOs that organize their demand through referrals received from primary care dentists who have participated in continuing education actions for dental professionals presented a higher frequency of satisfied users.

CONCLUSIONS

Characteristics of the process and structure were associated with user satisfaction, but a quality of care was perceived by users, mainly due to structural characteristics.

Role of management and human resource factors on matrix support in secondary oral health care in Brazil

OBJECTIVES

To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil.

METHODS

This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI).

RESULTS

Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99).

CONCLUSIONS

Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.

Factors associated with the performance of primary dental health care in Brazil: A multilevel approach

This study evaluated the factors associated with the performance of Brazilian Oral Health Teams (OHTs).This is multilevel research that used data from 12,386 Brazilian OHTs in 2012. The OHTs performance was estimated in previous research by using Item Response Theory model, which employed 20 questions about dental procedures in Primary Care. The first level covariates were based on OHTs procedures such as: the record of pregnant woman dental appointment, provision of dentistry home care, dental appointments scheduled choices, and OHTs in charge for more than 5000 individuals. Moreover, the use of guidelines was accessed concerning delivering prostheses in primary care, referring to secondary care, referring to suspected oral cancer, and providing care towards patients with special needs. Variables included in level 2 were GINI and Human Development Index. Multilevel linear regression models were constructed, estimating linear regression coefficients, 95% confidence intervals, and P values.OHTs performance was different among the 3,613 municipalities analyzed (P < .001), with 36.7% of the variation in the performance of the OHTs being attributed to the variability between municipalities. The adjusted model showed that higher performance OHTs reported attention to pregnant women, dentistry home care and use of dental care guidelines (P < .001). There were lower performance scores for those OHTs with more restricted scheduling (P < .05), compared to those that reported scheduling appointments at any day and time. The best OHTs and population ratio led to a better performance score (P = .010). At the municipal level, better socioeconomic status was associated with better performance of the OHTs (P < .001).OHTs with higher performance are associated with oral health services organizations and municipalities' socioeconomic status.

Construction and Validation of a Tool for the Assessment of the Oral Health in Primary Health Care Through the Perspective of Patients

OBJECTIVE: To construct and validate a questionnaire to evaluate the quality of oral health services in primary health care, from patients. METHODS: Initially a theoretical model of evaluation of Primary Health Care was elaborated, based on the evaluation of primary care and integrality in primary care. This model served as the basis for the script of a focus group with patients, aiming to verify the attributes perceived as important for such evaluation. The focus group results substantiated the first version of the questionnaire. Content validation was performed through a committee of experts (five teachers/researchers) and face validation in two pre-tests (37 patients each pre-test). For construct validation, factor analysis was performed and reliability (Kappa coefficient) and internal consistency (Cronbach&#39;s alpha) were verified. RESULTS: Thirty questions were considered for exploratory factor analysis. The anti-image matrix of covariances showed the need to exclude fourteen questions (values &lt;0.5). After this initial analysis, 16 questions remained in the questionnaire. The KMO test, considering the 16 questions, presented a value of 0.84. Cronbach&#39;s alpha was 0.919. The final version contains 16 questions divided into two dimensions: my health unit and the care in my health unit. CONCLUSIONS: The questionnaire allows a strategy that easily evaluates oral health services in primary care, based on the perception of patients.

Understanding oral health care team performance in primary care: A mixed-method study

Objective

This study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance.

Material & methods

A mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis.

Results

Quantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services.

Conclusion

Despite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses.

Analysis of the oral health care network development in Minas Gerais state, Brazil

OBJECTIVES

This study aimed to analyze the development stage of the oral health care network of the Brazilian Unified Health System in the state of Minas Gerais, Brazil.

METHODS

A cross-sectional descriptive and analytical study was conducted with 205 municipal oral health coordinators from the state. Data collection was carried out through a validated questionnaire to analyze the state of development of the oral health care network. Descriptive and cluster analysis were performed, and two clusters were generated.

RESULTS

The total median score of the questionnaires classified Minas Gerais as a state with incipient oral health care networks and a minimal capacity to operate such networks, reflected in the predominance of cluster 1 in the sample. There was no statistical association between age, time since graduation, and time spent working as a coordinator and the clusters (Mann-Whitney test). The coordinators' gender and educational level were also not statistically associated with the clusters (Pearson's chi-square and Fisher's exact, respectively).

CONCLUSION

There is a great need to improve the organization of services of the oral health care network in Minas Gerais. This can be done through improvements in its operational structure, as well as investment in management training.

A Survey About Dental Instruments at the Primary Health Care in Brazil

Abstract This study describes the structure of oral health services in primary health care in Brazil and the instruments available for the provision of oral health care and to compare the number of instruments according to organizational characteristics of health services and among the macroregions. Of the 23,251 oral health teams (OHTs) in the Public Health System, 17,513 (75.3%) participated in this study. Trained researchers observed the structures of the health services and determined the presence of and whether a sufficient quantity of 36 dental instruments existed. The score of each oral health service was determined by the sum of the number of dental instruments present in sufficient quantity (0 to 36). Central tendency measures were compared along with the variability in these scores according to the organizational characteristics of the services and according to the Brazilian macroregion. No instrument was found to be present in all evaluated services. Basic, surgical and restorative instruments were the most frequently found. Periodontal, endodontic and prosthetic instruments exhibited the lowest percentages. The mean and median numbers of dental instruments were higher for teams that operated over more shifts, those with an oral health technician and those in the South and Southeast regions. The oral health services were equipped with basic, surgical and restorative instruments. Instruments designed for periodontal diagnosis, emergency care and denture rehabilitation were less frequently found in these services. The worst infrastructure conditions existed in the OHTs with the worst forms of care organization and in regions with greater social issues.

Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

A integralidade no cotidiano da atenção à saúde bucal: revisão de literatura

O objetivo deste trabalho foi realizar uma revisão integrativa na literatura sobre integralidade e atenção à saúde bucal. Pesquisaram-se publicações posteriores a 2004, oficiais (site do Ministério da Saúde) e trabalhos acadêmicos (Biblioteca Virtual em Saúde), com utilização de cinco descritores (‘integralidade saúde bucal’, ‘integralidade odontologia’, ‘integrality oral health’, ‘comprehensiveness oral health’, ‘integralidade’ – filtro ‘saúde bucal’). Após critérios de exclusão, foram lidas e analisadas, à luz dos sentidos da integralidade, 39 referências, dentre elas dois documentos oficiais e 37 trabalhos acadêmicos. Posturas profissionais diferenciadas, o modo como os serviços de saúde são organizados e o planejamento de políticas voltadas para a integralidade são conteúdos presentes nos trabalhos. A ideia de integralidade esteve ligada aos seus dispositivos (acolhimento, vínculo, responsabilização), à formação acadêmica, ao trabalho em equipe e à necessidade de diferentes níveis de assistência. Outros aspectos, como processo de trabalho, mecanismos de gestão e intersetorialidade, devem fazer parte de estudos futuros que envolvam a interface da integralidade com a saúde bucal.

Who did not appear? First dental visit absences in secondary care in a major Brazilian city: a cross-sectional study

The study sought to identify possible factors associated with non-attendance at first dental appointments scheduled in 2011 of users living in Belo Horizonte, Minas Gerais, who were referred from primary care to different dental specialties in secondary care within the public health services of the city. A cross-sectional study was conducted based on research in secondary data bases of the public health regulatory system. The dependent variable was "no shows" for scheduled appointments, and the independent variables were age, time on the waiting list, gender, health district, and the specialty to which the individual was referred. Among the 6,428 first dental visits scheduled for 2011 in the specialties selected for analysis, 32.9 % were not performed due to the absence of the user. Bivariate analysis revealed a statistically significant association between non-attendance of the user and the five independent variables. Young adults, male, and resident in given districts who were referred to the specialties of surgery and endodontics and who waited longer on the waiting list exhibited a higher frequency of no-shows.

Análise da atenção secundária em saúde bucal no estado de Minas Gerais, Brasil

Este estudo descreveu e analisou os procedimentos especializados ambulatoriais nas áreas de periodontia, endodontia e cirurgia bucal em Minas Gerais, 2010. Utilizou-se dados secundários dos procedimentos realizados nos estabelecimentos de saúde e registrados no Sistema de Informação do Sistema Único de Saúde. A análise descritiva e bivariada foi realizada, considerando p < 0,05. Foram executados 707.559 procedimentos em 2.547 unidades de saúde distribuídas em 693 (81%) municípios. Destes procedimentos, 55% são da área de cirurgia, 28% da periodontia e 17% são da endodontia. As unidades são predominante públicas, sob administração municipal, 52,5% possuem alguma equipe de saúde bucal (ESB), 96,9% não tem habilitação como Centros de Especialidades Odontológicas (CEO). Os CEO são mais eficientes que as demais unidades (p < 0,001), mas há importante percentual que não cumpre as metas do Ministério da Saúde. Os municípios com CEO possuem maior população, mais ESB, menor cobertura potencial por estas e melhores IDH. Um significativo número de procedimentos especializados é realizado, especialmente em estabelecimentos de atenção básica. CEO são mais eficientes do que os não CEO, considerandose a média de procedimentos realizados. As metas de produção mínima são cumpridas por uma minoria de CEO.

Adaptação da versão saúde bucal do instrumento de diagnóstico do estágio de desenvolvimento da rede de atenção à saúde

A implantação de redes de atenção à saúde bucal é um processo recente e necessita de ser avaliado. Este estudo objetivou descrever as etapas de adaptação da versão saúde bucal de um instrumento para avaliar o estágio de desenvolvimento da rede de atenção à saúde no Sistema Único de Saúde do Brasil. O instrumento original, denominado Instrumento de Diagnóstico do Estágio de Desenvolvimento da Rede de Atenção à Saúde, foi desenvolvido por Mendes (2011). Foi realizada a avaliação formal dos significados geral e referencial do instrumento original, chegando-se à versão adaptada. Para isso, o instrumento foi analisado por um comitê de especialistas da área em questão. A compreensão da versão adaptada foi avaliada em um pré-teste aplicado para 20 coordenadores municipais de saúde bucal de Minas Gerais. Constatou-se uma boa equivalência conceitual, funcional, de itens, semântica e operacional entre os instrumentos. A versão saúde bucal foi bem compreendida, apresentando-se adequada para ser testada quanto às suas propriedades psicométricas. Essa etapa se encontra em fase de conclusão.

A survey of the sociodemographic and educational characteristics of oral health technicians in public primary health care teams in Minas Gerais, Brazil

BACKGROUND

To describe some sociodemographic and educational characteristics of oral health technicians (OHTs) in public primary health care teams in the state of Minas Gerais, Brazil.

METHODS

A cross-sectional descriptive study was performed based on the telephone survey of a representative sample comprising 231 individuals. A pre-tested instrument was used for the data collection, including questions on gender, age in years, years of work as an OHT, years since graduation as an OHT, formal schooling, individual income in a month, and participation in continuing educational programmes. The descriptive statistic was developed and the formation of clusters, by the agglomerative hierarchy technique based on the furthest neighbour, was based on the age, years of work as an OHT, time since graduation as an OHT, formal schooling, individual income in a month, and participation in continuing educational programmes.

RESULTS

Most interviewees (97.1%) were female. A monthly income of USD 300.00 to 600.00 was reported by 77.5% of the sample. Having educational qualifications in excess of their role was reported by approximately 20% of the participants. The median time since graduation was six years, and half of the sample had worked for four years as an OHT. Most interviewees (67.6%) reported having participated in professional continuing educational programmes. Two different clusters were identified based on the sociodemographic and educational characteristics of the sample.

CONCLUSIONS

The Brazilian OHTs in public primary health care teams in the state of Minas Gerais are mostly female who have had little time since graduation, working experience, and formal schooling sufficient for professional practice.

[Responsibilities of oral health technician in the family health strategy in Minas Gerais, Brazil]

The scope of this article is to analyze the self-reporting of duties performed by the Oral Health Technicians in the State of Minas Gerais. A cross-sectional descriptive study was conducted through telephone interviews, with a representative sample of 231 workers. The descriptive analysis involved the calculation of proportions. It was found that 71.6% (95% CI, 64.4 to 77.5) performed coronal polishing, 63.2% (95% CI, 56.1 to 69.7) carried out scaling of dental calculus and 14.7% (95% CI, 10.3 to 15.4) inserted restorative materials. Regarding preventive/collective actions, 100% (95% CI, 97.6 to 100.0) participated in educational activities, 99% (95% CI, 96.1 to 99.8) demonstrated oral hygiene techniques, 96.6% (95% CI, 92.7 to 98.4) administrated topical fluoride, 77.9% (95% CI, 71.5 to 83.3) made home visits, and 96.6 % (95% CI, 92.7 to 98.4) performed collective actions, especially in schools. Oral Health Technicians have spent their more time on preventive/collective activities than on individual clinical care.

Exploring professionalization among Brazilian oral health technicians

Professional dental auxiliaries emerged in the early 20th century in the United States of America and quickly spread to Europe and other regions of the world. In Brazil, however, oral health technicians (OHTs), who occupy a similar role as dental hygienists, had a long journey before the occupation achieved legal recognition: Brazilian Law 11.889, which regulates this occupation in the country, was only enacted in 2008. The aim of this paper is to review the literature on the professionalization of OHTs, highlighting the triggering, limiting and conflicting aspects that exerted an influence on the historical progress of these professionals in Brazil. We have tested Abbott's and Larson's theory on professionalization, against the history of OHTs. A number of different dental corporative interests exerted an influence over professionalization, especially in discussions regarding the permissible activities of these professionals in the oral cavity of patients. With primary health care advances in Brazil, the importance of these professionals has once again come to the forefront. This seems to be a key point in the consolidation of OHTs in the area of human resources for health in Brazil.

Nem tudo é estágio: contribuições para o debate

O artigo versa sobre o estágio supervisionado, tratando-o como uma oportunidade fundamental de consolidação do espaço pedagógico, capaz de enfrentar, positivamente, os desafios lançados pelas Diretrizes Curriculares para os Cursos de Graduação em Odontologia. Não se trata de uma proposta nova, mas de uma luta pela transformação das práticas de ensino que tem origem nos anos setenta, no movimento de integração docente assistencial, até os dias atuais. Aborda o espaço dos serviços públicos de saúde e o mundo do trabalho como aspectos centrais de uma nova prática pedagógica, com potencial para se alcançar um perfil profissional com consciência crítica e capacidade de compreender a realidade e intervir sobre ela. Aponta para os riscos de se compreender e confundir estágio com prática intramuros, reproduzindo, sob o nome de estágio curricular supervisionado, práticas tradicionais, com ênfase em aspectos tecnicistas e biologicistas sem potência para alcançar as mudanças propostas pelas Diretrizes Curriculares. Ao ressaltar a importância do estágio curricular supervisionado na formação profissional, fica estabelecido um diálogo com a ABENO, contestando algumas de suas posições. Neste sentido, o artigo mostra a necessidade de uma discussão que agregue o maior número possível de faculdades de odontologia.

Gerenciamento de resíduos sólidos de odontologia em postos de saúde da rede municipal de Belo Horizonte, Brasil

OBJECTIVE

To investigate whether municipal health clinics in the city of Belo Horizonte, Brazil, comply with the legal requirements for managing dental wastes.

METHOD

We collected information from 54 of the city's 105 municipal health clinics that provide dental care. At each clinic we interviewed the clinic manager, one dental assistant, and one general assistant. Based on the requirements outlined in the Belo Horizonte Health Waste Management Manual, we assessed characteristics in the following three areas: (1) technical and operational (waste classification and characterization, minimization, segregation, pretreatment, conditioning, collection and internal and external transportation, and external storage); (2) general and organizational (inspection, amount of clinic space, environmental permits, floor plan showing waste-generating areas, and whether the clinic had a technical specialist responsible for managing the health wastes); and (3) human resources (employee vaccination records and oversight, occupational safety and occupational medicine program, environmental risk prevention program, medical oversight and occupational health program, hospital (clinic) infection control committee, and training in health waste management).

RESULTS

The clinics produced an average of 270 liters of solid waste per day. None of the clinics surveyed had a plan for managing health wastes. The only requirements with which all the clinics complied were: segregation of needles and mercury, adequately identified cardboard containers used for disposal of cutting and piercing items, and daily internal collection and transportation of wastes.

CONCLUSIONS

When the risks associated with each class of waste have not been established, all the wastes should be considered potentially dangerous. Further, a law by itself does not guarantee that the public's health will be protected. Before public agencies impose legal requirements, it is necessary to know if the agencies themselves are capable of enforcing those requirements. Any proposed waste management legislation should be based on scientific research.