COMPREHENSIVE DENTAL CARE IN PRIMARY CARE DENTISTRY SERVICES IN BRAZIL

Abstract

In 2012, a Program for Improving Access and Quality of Primary Health Care (PMAQ-AB) was implemented in Brazil to expand access to Primary Health Care (PHC), including dental care (added in 2000), and improve quality standards nationwide. The aim of this study was to evaluate the provision of comprehensive clinical dental care by PHC services.

Methods: A national census of the 18,114 PHC dental services that took part in PMAQ-AB. Co- variates included characteristics of the service and primary care dentists. The outcome, provision of comprehensive clinical dental care, was deemed present if a PHC dental service provided the following: scaling, composite and amalgam restorations, tooth extractions and pulpectomy. In addition, the presence of minimum equipment and materials to perform the above mentioned clinical care was evaluated. All services were evaluated by researchers trained for this purpose by research institutions all over Brazil under guidance of the Ministry of Health. Tablet computers were used for data input. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Sul. Prevalence ratios were calculated by means of Poisson regression with robust variance.

Results: 1190 PHCs did not have minimum equipment and were excluded from the analysis. Only 5% (N=840) of the PHC dental services provided comprehensive care and had the minimum set of materials and equipment. With regards of the PHC services, high quality was found in services with the most dentists (Prevalence Ratio (PR) 1.16 [95%CI 1.14-1.19]), greater workload (PR 1.63 [95%CI 1.74-1.84]), where management provided information for health situation analysis (PR 1.14 [95%CI 1.11-1.17]), which carried out monitoring of indicators of oral health (PR 1.12 [95%CI 1.10-1.15]) and which planned and programmed the oral health actions monthly with primary care teams (PR 1.03 [95%CI 1.01-1.05]). With regards of the dentist, higher quality was found in those who showed better employment ties (PR 1.27 [95%CI 1.23-1.32]), who had a career plan (PR 1.10 [95%CI 1.08-1.13]), had a post graduate qualification in public health (PR 1.06 [95%CI 1.05-1.09]) and undertook continuing education (PR 1.23 [95%CI 1.19-1.27]).

Conclusion: It is suggested that improvements are needed in the infrastructure of the dental offices of primary health care, as well as incentives for implementing changes in the health centers and incentives for the SUS (Unified Health System) for health professionals, so that changes reflect improving quality of care.