Fatores associados ao acesso da gestante à consulta odontológica

Abstract

Service evaluation aims to form a critical opinion, facilitate development and contribute to knowledge in the areas or services being evaluated. To monitor the population's access and the quality of health services provided in primary care, the Access and Quality Improvement Program (PMAQ-AB) was created. In this context, the objective was to analyze the pregnant woman's access to dental appointments at SUS, in the national territory, considering the organization of the work process of Primary Care Teams and Oral Health Teams. This is a longitudinal study, nationwide, carried out with secondary data, publicly available on the website of the Secretariat of Primary Health Care of the Ministry of Health, referring to cycles 2 and 3 of the PMAQ-AB, in 2013 and 2017. A The reference population comprised all the Teams of Primary Health Care professionals located in health units in all 26 Brazilian states and the Federal District, who participated in the two evaluation cycles and responded to Module II - Interview with the professional of the Health Care Team. Primary Care (eAB) and Module VI – Interview with a Professional from the Oral Health Team (eSB), during the application of the External Assessment instrument. Databases were linked sequentially using the common variable INE. McNemar test and multilevel logistic regression were used to analyze the positive (practice was incorporated in cycle 3) or negative (practice was abandoned in cycle 3) variation of the dental appointment record between cycles and the association between work process variables of the eAB and eSB with this variation. The percentage of records of the pregnant woman's dental appointment by the eAB was 64.82% (n=19303) and 82.33% (n=30750) in cycles 2 and 3, respectively. Regarding the eSB's work process, the greatest differences were observed for recording in electronic medical records, carrying out self-assessment and planning actions. The negative variation was greater than the positive for continuity of treatment and resolution of complex cases. There was a positive variation for 9 of the 11 work process variables of the eAB, highlighting the biggest differences between positive and negative variation regarding the organization of the agenda in relation to risk, institutional support, self-assessment, possession of a map of the territory covered and support for the resolution of complex cases. There was no significant variation in the planning of actions by eAB between the two cycles. Although 1.85% of the teams stopped using the pregnant woman's booklet, this variation was not significant. It was observed that the more favorable work process of the eAB and the eSB was significantly associated with a higher number of dental appointments by the pregnant woman, explaining part of the variation between cycles. The work process of the oral health teams and primary care teams favored the pregnant woman's dental appointment.