Specialized Dental Care in the Brazilian Unified National Health System (SUS)

Trezena, Samuel; Oliveira, Fabrício Emanuel Soares de; Dias, Verônica Oliveira; Martelli, Petrônio José de Lima; Martelli, Daniella Reis Barbosa; Martelli Júnior, Hercílio

doi:10.1590/pboci.2023.051

Acessibilidade / Reportar erro

Brasil

Pesquisa Brasileira em Odontopediatria e Clínica Integrada

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 23 • 2023 • https://doi.org/10.1590/pboci.2023.051 copy

Specialized Dental Care in the Brazilian Unified National Health System (SUS)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO.

Material and Methods:

Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination.

Results:

The total of 932 CEO’s were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO’s had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases.

Conclusion:

Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO’s actions was evidenced, mainly related to the work processes.

Keywords:
Dental Health Services; Health Care Quality; Access; and Evaluation; Specialties; Dental.

Geographic Region	Federative Unit	Type I N (%)	CEO’s Type Type II N (%)	- 1º Cycle Type III N (%)	Total N (%)	Total N (%)	Type I N (%)	CEO’s Type Type II N (%)	- 2^º Cycle Type III N (%)	Total N (%)	Total N (%)
North	Acre Amazonas	1 (0.1) 2 (0.2)	1 (0.1) 8 (0.9)	0 (0.0) 1 (0.1)	2 (0.2) 11 (1.2)	60 (6.3)	1 (0.1) 2 (0.2)	1 (0.1) 8 (0.8)	0 (0.0) 3 (0.3)	2 (0.2) 13 (1.2)	66 (6.4)
	Amapá Pará	1 (0.1) 16 (1.7)	0 (0.0) 8 (0.9)	2 (0.2) 5 (0.5)	3 (0.3) 29 (3.1)		0 (0.0) 18 (1.7)	0 (0.0) 10 (1.0)	2 (0.2) 4 (0.4)	2 (0.2) 32 (3.1)
	Rondônia Roraima	0 (0.0) 0 (0.0)	6 (0.6) 1 (0.1)	1 (0.1) 0 (0.0)	7 (0.7) 1 (0.1)		0 (0.0) 0 (0.0)	7 (0.8) 2 (0.2)	1 (0.1) 0 (0.0)	8 (0.8) 2 (0.2)
Northeast	Tocantins Alagoas	4 (0.4) 11 (1.2)	2 (0.2) 10 (1.1)	1 (0.1) 1 (0.1)	7(0.7) 22 (2.4)	357 (38.4)	4 (0.4) 16 (1.5)	1 (0.1) 9 (0.9)	2 (0.2) 0 (0.0)	7 (0.7) 25 (2.4)	410 (39.3)
	Bahia Ceará	29 (3.1) 37 (4.0)	38 (4.1) 16 (1.7)	8 (0.9) 27 (2.9)	75 (8.0) 80 (8.6)		31 (3.0) 31 (3.0)	40 (3.8) 13 (1.2)	7 (0.7) 30 (2.9)	78 (7.5) 74 (7.1)
	Maranhão Paraíba	3 (0.3) 33 (3.5)	22 (2.4) 16 (1.7)	1 (0.1) 4 (0.4)	26 (2.8) 53 (5.7)		6 (0.6) 60 (5.8)	20 (1.9) 18 (1.7)	2 (0.2) 4 (0.4)	28 (2.7) 82 (7.9)
	Pernambuco Piauí	17 (1.8) 14 (1.5)	21 (2.3) 13 (1.4)	2 (0.2) 1 (0.1)	40 (4.3) 28 (3.0)		26 (2.5) 16 (1.5)	26 (2.5) 13 (1.2)	6 (0.6) 1 (0.1)	58 (5.6) 30 (2.9)
	Rio Grande do Norte Sergipe	0 (0.0) 0 (0.0)	21 (2.3) 7 (0.8)	2 (0.2) 3 (0.3)	23 (2.5) 10 (1.1)		1 (0.1) 0 (0.0)	22 (2.1) 8 (0.8)	2 (0.2) 2 (0.2)	25 (2.4) 10 (1.0)
Centre-west	Federal District Goiás	2 (0.2) 7 (0.8)	7 (0.8) 15 (1.6)	0 (0.0) 6 (0.6)	9 (1.0) 28 (3.0)	6z (6.7)	2 (0.2) 12 (1.2)	7 (0.7) 17 (1.6)	0 (.0) 5 (0.5)	9 (0.9) 34 (3.3)	71 (6.8)
	Mato Grosso do Sul Mato Grosso	4 (.4) 1 (0.1)	10 (1.1) 8 (0.9)	1 (0.1) 1 (0.1)	15 (1.6) 10 (1.1)		3 (0.3) 1 (0.1)	11 (1.1) 4 (0.4)	1 (0.1) 8 (0.8)	15 (1.4) 13 (1.2)
South	Paraná Rio Grande do Sul	14 (1.5) 16 (1.7)	22 (2.3) 8 (0.9)	12 (1.3) 1 (0.1)	48 (5.1) 25 (2.7)	116 (12.4)	12 (1.2) 22 (2.1)	21 (2.0) 11 (1.1)	15 (1.4) 1 (0.1)	48 (4.6) 34 (3.3)	131 (12.6)
Southeast	Santa Catarina Espírito Santo	25 (2.7) 6 (0.6)	15 (1.6) 02 (0.2)	3 (0.3) 1 (0.1)	43 (4.6) 9 (1.0)	337 (36.2)	28 (2.7) 7 (0.7)	17 (1.6) 1 (0.1)	4 (0.4) 1 (0.1)	49 (4.7) 9 (0.9)	364 (34.9)
	Minas Gerais Rio de Janeiro	27 (2.9) 16 (1.7)	54 (5.8) 44 (4.7)	2 (0.2) 6 (0.6)	83 (8.9) 66 (7.1)		31 (3.0) 19 (1.8)	54 (5.2) 47 (4.5)	6 (0.6) 8 (0.8)	91 (8.7) 74 (7.1)
	São Paulo TOTAL	63 (6.8) 349 (37.4)	99 (10.6) 474 (50.9)	17 (1.8) 109 (11.7)	179 (19.2) 932 (100.0)	932 (100.0)	69 (6.6) 418 (40.1)	100 (9.6) 488 (46.8)	21 (2.0) 136 (13.1)	190 (18.2) 1042 (100.0)	1042 (100.0)

		1^º Cycle				2^º Cycle			p-value
Variables	N	Mean^a a Mean by Establishments;	SD^b b Standart Deviation;	CI95%	N	Mean	SD^b b Standart Deviation;	CI95%
Dentists by Specialty
Oral Surgery	1.511	1.6	1.6	1.5-1.7	1.576	1.5	0.8	1.4-1.5	0.065
Endodontics	2.403	2.5	3.4	2.3-2.8	2.443	2.3	1.4	2.2-2.4	0.054
Oral Medicine	828	0.8	1.9	0.7-1.0	876	0.8	0.7	0.8-0.8	0.483
Dentistry for Special Needs Users	1.347	1.4	2.2	1.3-1.5	1.379	1.3	1.0	1.2-1.3	0.133
Periodontics	1.484	1.5	2.3	1.4-1.7	1.423	1.3	0.8	1.3-1.4	0.005^c c Student's t test;
Dental Prosthesis	1.264	2.2	3.6	1.9-2.5	1.046	1.2	1.2	1.2-1.3	<0.001^c c Student's t test;
Weekly workload^e e Number of Dental Specialty Centers that Answered the Question.
Oral surgery	932	30.6	20.3	29.3-32.0	1.024	32.6	20.5	32.0-35.5	0.034^c c Student's t test;
Endodontics	932	49.2	33.8	47.0-51.4	1027	51.5	33.5	51.1-56.3	0.122
Oral Medicine	932	15.0	35.6	12.7-17.3	739	21.5	15.9	20.6-23.2	<0.001^c c Student's t test;
Dentistry for Special Needs Users	932	26.4	18.2	25.2-27.5	958	31.1	24.5	30.5-34.7	<0.001^c c Student's t test;
Periodontics	932	29.6	23.6	28.1-31.1	997	31.4	26.1	30.1-34.6	0.042^d d Mann-Whitney U test;
Dental prosthesis	541	31.7	19.7	30.0-33.3	609	36.5	28.3	34.2-38.8	0.001^c c Student's t test;
Estimated Number of
Days to be Attended^e e Number of Dental Specialty Centers that Answered the Question.
Oral surgery	441	35.9	65.8	35.7-49.4	961	58.1	107.9	51.3-65.0	<0.001^c c Student's t test;
Endodontics	441	67.0	90.7	64.2-82.5	949	83.4	119.5	75.8-91.0	<0.001^c c Student's t test;
Oral Medicine	441	7.1	11.9	6.1-8.0	829	7.9	16.4	6.8-9.0	<0.001^c c Student's t test;
Dentistry for Special Needs Users	441	14.6	30.3	12.0-17.7	933	17.2	35.2	14.9-19.5	<0.001^c c Student's t test;
Periodontics	441	28.0	57.3	24.5-35.6	936	34.6	79.1	29.5-36.6	<0.001^c c Student's t test;
Dental prosthesis	441	111.2	127.0	97.9-121.1	690	118.4	180.4	104.9-131.8	<0.001^c c Student's t test;

Variables	1^rt Cycle N (%)	2^nd Cycle N (%)	p-value^a
CEO’s work process CEO's management
Manager with role accumulation	347 (37.5)	339 (43.0)	<0.001^a
Exclusive manager	464 (50.2)	403 (51.0)
There is no manager in the CEO Offer of other specialties (except minimum specialties)	114 (12.3)	48 (6.0)
Yes	728 (78.1)	813 (78.0)	1.000
No	204 (21.9)	229 (22.0)
Action planning activities
Yes	721 (77.7)	831 (82.0)	0.020^a
No	207 (22.3)	183 (18.0)
Monitoring and analysis of established goals (By specialty)
Yes	792 (85.3)	930 (91.7)	<0.001^a
No	136 (14.7)	84 (8.3)
Team's periodic self-assessment
Yes	678 (73.1)	761 (75.0)	0.325
No	250 (26.9)	253 (25.0)
Support from other professionals to solving complex cases
Yes	603 (65.0)	791 (78.0)	<0.001^a
No	325 (35.0)	223 (22.0)
CEO's matrix support to the Primary care oral health teams in the resolution of complex cases
Yes	656 (70.7)	878 (86.6)	<0.001^a
No	272 (29.3)	136 (13.4)
Support frequency for Primary care oral health teams
Often	230 (35.1)	361 (41.1)	0.017^a
Without frequency	426 (64.9)	517 (58.9)
CEO professionals' actions carried out with Primary care oral health teams Discussion of difficult and challenging clinical cases and sentinel events
Yes	482 (73.5)	776 (86.1)	<0.001^a
No	174 (26.5)	122 (13.9)
Clinical actions shared with professionals from the Primary care oral health teams
Yes	489 (74.5)	663 (75.5)	0.676
No	167 (25.5)	215 (24.5)
Training detection of oral cancer with Primary care professionals
Yes	358 (54.6)	627 (71.4)	<0.001^a
No	298 (45.4)	251 (28.6)
Joint construction of therapeutic projects with Primary care oral health team professionals
Yes	276 (42.1)	458 (52.2)	<0.001^a
No	380 (57.9)	420 (47.8)
Continuing education activities together with Primary care oral health team professionals
Yes	351 (53.5)	601 (68.5)	<0.001^a
No	305 (46.5)	277 (31.5)
Clinical protocols construction and discussion Yes	483 (73.6)	706 (80.4)	0.002^a
No	173 (26.4)	172 (19.6)
Reference's criteria agreement by specialty
Yes	581 (88.6)	756 (85.1)	0.165
No	75 (11.4)	122 (13.9)
When requested, the CEO's professionals carry out home care visits with primary care oral health teams
Yes	315 (48.0)	461 (52.5)	0.089
No	341 (52.0)	417 (47.5)
Clinical record's use
Clinical record’s use
Yes	908 (97.8)	1003 (98.9)	0.070
No	20 (2.2)	11 (1.1)
Electronic clinical record's use
Yes	73 (8.0)	186 (18.5)	<0.001^a
No	835 (92.0)	817 (81.5)
Electronic clinical records integrated with the others point network
Yes	56 (76.7)	156 (83.9)	0.210
No	17 (23.3)	30 (16.1)
CEO' Access, reference and counter-referral
CEO’s access
Spontaneous demand	12 (1.3)	07 (0.7)	0.075
Referenced demand	531 (57.2)	625 (61.6)
Mixed demand	385 (41.5)	382 (37.7)
Referrals vaccancy offer to care in hospital environment
Quota system	121 (21.9)	148 (19.5)	0.375
Without limited number	364 (65.8)	548 (69.5)
Others	68 (12.3)	84 (11.1)
Pent-up demand for hospital-level care
Yes	110 (19.9)	159 (20.9)	0.064
No	409 (74.0)	575 (75.7)
Without knowledge	34 (6.1)	26 (3.4)
Reference for oral cancer confirmed cases
Yes	742 (80.0)	920 (90.7)	<0.001^a
No	186 (20.0)	94 (9.3)

Associação de Apoio à Pesquisa em Saúde Bucal Avenida Epitácio Pessoa, 4161 - Sala 06, Miramar, CEP: 58020-388, João Pessoa, PB - Brasil, Tel.: 55-83-98773 2150 - João Pessoa - PB - Brazil
E-mail: apesb@terra.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Samuel Trezena, Postgraduate Program in Primary Health Care, Center of Biological and Health Sciences, State University of Montes Claros, Av. Prof. Rui Braga, s/n, Vila Mauriceia, Montes Claros, MG, Brazil. 39408-354. E-mail:samueltrezena@gmail.com