Avaliação do processo de trabalho das equipes de saúde bucal da atenção básica brasileira

Abstract

This thesis aimed to evaluate the work process of the Oral Health Teams (OHT) in Brazilian Primary Health Care and their relationship with municipal context variables, such as geopolitical region, Human Development Index (HDI), population size, and oral health coverage in the Family Health Strategy. All OHTs that joined the Access and Quality Improvement Program for Primary Health Care (PMAQ-AB) in the third cycle (2017/2018) were included. Data from Module VI (interview with OHT professionals and document verification at the health unit) of the External Evaluation of the Program were analyzed. The first article evaluated the relationship between the OHTs and other points in the primary health care network. It was found that the provision of reference services for OHTs is almost universal. However, 53% of the teams indicated that emergency services were not available outside of OHT working hours, and 30% did not have records of referred users. Less than 73% of the health networks and specialties provided matrix support to the OHTs. Most of the evaluated aspects had a lower prevalence in the North region, in cities with lower HDI, and in smaller municipalities. The second article evaluated the work of oral health auxiliaries and technicians. It was observed that 20% of the teams had dental prosthesis technicians, while 89% had dental office auxiliaries. Most dental procedures are universal, but less than 25% of the OHTs performed procedures related to oral rehabilitation/dental prostheses. The prevalence of services provided was generally lower in the North region, in smaller municipalities, and in those with lower HDI. The third article evaluated the organization of patient records and scheduling for oral health care. It was found that 80% of the OHTs had integrated dental clinical records with the patient’s medical record, but only 11% exclusively used electronic records. More than half of the OHTs scheduled the first dental appointment at the dental office, while 81% scheduled the continuity of treatment at the end of the previous consultation. In the North and Northeast regions, and in municipalities with lower HDI, the use of electronic records was less frequent, but community health agents were more involved in scheduling the first dental appointment. The conclusion was that it is necessary to provide Family Health training for teams; provide communication resources, computers, internet, phones, and interoperable systems; improve the flow in the health network and establish regional agreements to better serve remote areas, aiming to promote equity; ensure OHTs are integrated with the Family Health Strategy, with community agents in all microareas and their actions reinforced; promote complete teams; expand the provision of emergency dental services; credential dental prosthesis laboratories in sufficient quantity; and universalize the electronic patient record e-SUS.