Produção odontológica da atenção primária à saúde dos municípios brasileiros

Abstract

This ecological study evaluated factors associated with the performance of dental procedures in Primary Health Care (PHC) in Brazilian municipalities in 2023, aiming to understand how socioeconomic and service organization aspects influence oral health production. In addition, it sought to develop technical products that could contribute to public health service advances in clinical data records. Data from 25 individual clinical dental procedures (promotion/prevention, clinical, prosthetic, and surgical) were collected from the Primary Health Care Information System (SISAB). The dependent variable “rate of procedures performed” was the ratio between the total number of procedures and the population of the municipality, dichotomized by the median. The covariates were socioeconomic (Human Development Index – HDI and Gini index; per capita income; illiteracy; urbanization; proportion of children, elderly, women and health insurance) and health services (coverage of Family Health Strategy (ESF) and Oral Health Teams (ESB); presence of Dental Specialties Center – CEO). The data were analyzed using simple and multiple binary logistic regression. More than 38 million procedures were performed, with clinical procedures being the most frequent (56.10%), followed by promotion/prevention (24.67%), surgical (17.30%) and prosthetic (1.94%). The outcome was associated with the Gini index, private health insurance coverage, ESB and ESF (p<0.05). Municipalities with greater socioeconomic inequality, measured by the Gini index, were less likely to perform procedures above the median (OR=0.23; 95%CI: 0.09-0.59; p=0.002). Municipalities with a higher proportion of the population with private health insurance (OR=1.01; 95%CI: 1.00-1.02; p=0.023), higher ESB coverage (OR=1.04; 95%CI: 1.04-1.05; p<0.001) and 100% ESF coverage (OR=1.79; 95%CI: 1.59-2.02; p<0.001) were more likely to perform procedures above the median. Contextual factors of health services and socioeconomic factors influenced dental production in Brazilian PHC. Regarding the technical product, three products were developed. The first was the development of an audiovisual material that presented theoretical concepts about the importance and processing of health production data, to guide professionals on the importance of correctly recording information. The theoretical part and the script of the video were developed by the researcher, while the audiovisual production was carried out with the support of a professional specialized in design and animation; the video was made available on the internet for free access. The second product was the creation of a professional training course for the oral health teams of the PHC of the municipality of Igarapé, Minas Gerais, with the objective of guiding professionals on the theoretical and practical aspects of records in information systems. The course was part of the continuing education program of the Municipal Health Department and lasted 4 hours. During the training, the third product was developed together with the professionals: a reception and recording flow for the main cases identified by the team as difficult to categorize, seeking to standardize conduct and ensure correct information recorded in the local system. The materials produced were made available to professionals free of charge.