Avaliação da qualidade da atenção em saúde bucal no Brasil: estrutura, processo e resultado

Abstract

The quality of oral health care in the Brazilian public service was evaluated through three descriptive and analytical studies: 1) user satisfaction assessment; 2) evaluation of the work process of the Oral Health Teams (OHT) comparatively between types I and II between the regions of Brazil; 3) association between work process and structure of health services and access and problem-solving capacity of OHT. Study based on secondary data from the National Program for Improving Access and Quality in Primary Care by interviews with health professionals of the OHT and users, and evaluation of structure of oral health services. User satisfaction was defined by the combination of questions regarding the perception of service performance; assessment of overall satisfaction and the intention to avoid the service in the future. The users who, at the same time, positively evaluated the included variables were considered satisfied. The exploratory variables were demographic characteristics and the quality of the primary service from the user's viewpoint. Latent Class Analysis was employed to identify OHT subgroups considering response patterns for work process variables. The latent variables characterized the work process that was compared between the regions of Brazil, according to the OHT composition. Access and problem-solving capacity were defined by the performance indicators of the OHT: Coverage of First Scheduled Dental Appointments (FDA), rated < or > mean and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA), rated < or > 1. The explanatory variables were structure and work process. Structure was evaluated by the sum of instruments, equipment and supplements for each OHT. The association were tested using a crude and multiple logistic regression analysis. A total of 37,262 users participated, and 65.51% reported satisfaction with oral health service, that was higher among those > 20 years old, beneficiaries of the Family Grant Program and who rated the oral health service positively; and lower among users with a higher level of schooling and those who reported being employed. A total of 16,189 (99.8%) and 16,192 (99.9%) OHT had complete data for work process and structure. Three latent variables were identified and the classes defined as consolidated, developing and incipient. In Brazil and the Southeast and South regions, the frequency of OHT with consolidated work process was significantly higher among type II OHT. 37.05% of OHT presenting FDA ≥ the mean and 91.92% presenting CT/FDA ≥ 1. The consolidated actions planning and better structural conditions were associated with better performance for the two indicators. OHT who served every day of the week people outside the coverage area and served in 2 to 9 Family Health Teams were associated with the FDA > mean and OHT with consolidated comprehensive care and who performed telehealth were associated with CT/FDA > 1. The improvement in the quality of oral health service in primary care can result in users more satisfied. OHT type II had potential for better work process, but there was disparity between regions. OHT with better structural and work process conditions had better performance.