Atenção odontológica à gestante no Sistema Único de Saúde: análise longitudinal de 4 anos

Abstract

‘Previne Brasil’ is the current financing model for Primary Health Care (PHC) in Brazil. Performance-related pay is one of the components of this program, whose financial incentive distributed to municipalities is calculated based on the result of seven performance indicators. The indicator that is most relevant for Dentistry is the one that evaluates the proportion of pregnant women with dental care performed. Despite government support, the percentage of pregnant women receiving dental care from the national health system (SUS) is still far from the goals established by the Ministry of Health. It is necessary to recognize the factors that contribute to a better performance of the municipalities. Therefore, it is important to understand the determinants of access to oral health services for vulnerable populations, such as pregnant women, for the organization of services, allocation of resources, definition of action strategies and monitoring of health indicators. Thus, this study aimed to evaluate the performance of Brazilian municipalities, between 2018-2021, regarding the indicator of dental care for pregnant women and to analyze the association of contextual variables with the conducting of Prenatal Dental Care (PDC) consultations within the scope of Brazilian municipalities. Contextual variables were Oral Health Coverage (OHC) in PHC, Municipal Human Development Index (MHDI) and population size. A longitudinal ecological study was developed, using the 5,570 Brazilian municipalities as units of analysis. Regression model for longitudinal data with unstructured covariance estimated quarterly variation. The intervention variable was defined, corresponding to the period of implementation of ‘Previne Brasil’ (2020/Q3) to evaluate the effect of the Program. There was a positive mean variation of the indicator in the period {β=0.09(0.08-0.10)}. Municipalities with higher OHC had a higher proportion of pregnant women with dental care {β=0.31(0.27-0.36)}. Lower proportions were observed in municipalities with high/very high MHDI {β=-0.54(-0.61;-0.47)}. There was a significant interaction between intervention, population size and four-month periods (quarters). There was a greater temporal variation of the indicator after the 2020/Q3 quarter, regardless of the population size of the municipalities (p<0.05). Thereby, in Brazil, between 2018 and 2021, there was an increase in the proportion of dental care provided to pregnant women assisted in public oral health services, especially after the implementation of the ‘Previne Brasil’ Program. A greater oral health coverage in the PHC, lower MHDI and population size were factors associated with the performance of PDC. The current PHC federal funding model may have had an inductive effect of the PDC on public health services in Brazil.