O processo de trabalho das equipes de saúde bucal no Brasil: análise comparativa entre o 2º e 3º ciclos do PMAQ-AB

Abstract

The aim of the present study was to perform a comparative analysis of the work process of oral health teams (OHTs) between the 2nd and 3rd cycles of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) with regards to greater or less adherence on the part of the teams to the National Oral Health Policy. A study with a national scope was conducted involving the five regions of Brazil using secondary data from the external evaluation phase obtained from public databases. The items on Module VI of the external evaluation instrument were analyzed and those with similarities enabling comparisons between the cycles were selected. Six variables were chosen. In the 2nd evaluative cycle, the records of each OHT were identified through the National Health Establishment Registry (NHER). In this cycle, there was no variable that identified each OHT. When a primary care unit had information on more than one OHT, the most positive response was used to represent the teams of the unit. The same procedure was adopted in the 3rd evaluative cycle. Thus, a single record per NHER was obtained in both cycles for the purposes of comparison. A total of 14,649 OHTs had complete data on the variables of interest in the two cycles. The data were submitted to descriptive analysis to obtain the frequencies of execution of the seven work process activities. McNemar’s test was used to determine the significance of changes between the two evaluative cycles. The disparity index (DI) was employed to estimate and compare the magnitude of the differences in the proportions of execution of the activities among the regions of the country and between the two evaluative cycles. This index indicates the mean deviation in the observed proportions in a region in relation to the reference proportion in percentage. Between the two evaluative cycles, was no using local information for the planning of actions of the OHT and this was the least incorporated activity either cycle. Self-evaluation by the OHTs had the lowest proportion of execution in the 2nd cycle but incorporated this activity the most between the 2nd and 3rd cycles. In the regional analysis, the highest percentages of execution of the activities were found in the northeastern region in both cycles, surpassing the national data for the majority of the activities analyzed. Within each evaluative cycle, the largest disparities among the regions regarded the performance of self-evaluations and planning based on local information. Between the evaluative cycles, the DI indicated a reduction of approximately 50% in the disparity among the regions regarding self-evaluation, whereas a 21.8% increase in disparity was found regarding planning based on local information. Inequality was found among the regions, especially in the use of planning based on local information. Improvements occurred between cycles regarding the execution of self-evaluation, whereas challenges persist in terms of the use of local information for planning. This study also enabled the organization of a workshop for the continued education of employees in the health field in the municipality of Betim/MG as well as administrators and students of dentistry performing internships in the public healthcare system in the municipality.