Análise do desempenho das equipes de saúde bucal na Estratégia Saúde da Família no Brasil: um estudo misto

• Ano de defesa: 2016
• Autor(a) principal: Clarice Magalhães Rodrigues dos Reis
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais
• Palavras-chave em Português: Saúde bucal; Cuidados primários de saúde; Saúde da família; Questionários; Avaliação de serviços de saúde
• Link de acesso: https://hdl.handle.net/1843/ODON-AJ4LMZ

The Family Health Strategy is the main organizational model of primary health care in Brazil. Dental care was included in the FHS in 2001 as a priority area due to the need to improve the oral health status of the population, and the oral health teams were created. In the last decade, there was a significant expansion of the ESF with the range of services reaching about 63% of the population in 2016. In 2011, the Brazilian Ministry of Health launched a program to assess the quality of FHSPrograma Nacional de Melhoria do Acesso e Qualidade da Atenção Básica PMAQ-AB. The main challenge of PMAQ-AB was to stimulate a culture of evaluation among FHS professionals and managers who evaluate processes and outcomes of the teams. This study aimed to describe the actions performed at primary health care by oral health teams in Brazil and to understand factors that contribute to differentperformance of each team. For this, a mixed sequential explanatory study was developed. In the quantitative phase, we undertook descriptive statistics and cluster analysis to describe the production of 12,403 OHTs, and applied Item Response Theory (IRT) to assess surveys 20 dental care questions psychometric properties. IRT results were used to sample OHTs with extreme scores performance to the next phase. In the qualitative phase, we used descriptive approach applying thematicanalysis in 10 dentists from extreme performance OHTs. Quantitative results showed OHTs provided basic dentistry clinical care, but underprovided rehabilitation with dentures and oral cancer care coordination. IRT analysis showed survey limitation to discriminate OHTs performance, except for rehabilitation with dentures and oral cancer-related items that tend to discriminate high-performance OHTs. Qualitative data showed barriers to access oral health services and failures for integrating oral cancer delivery services. Dentists empathy and altruism determine the quality of oral cancer care coordination by means of their own network to refer patients suspect of oral cancer. OHTs that deliver dentures know better the population rehabilitation needs. Mixed method results showed the improvements in oral health services in Brazil, but pointed that in low performance OHT, patients face multiples barriers to access services. Also, low performance OHT failed to following oral câncer patients, and provided dentures.