Background The World Health Organization has advocated for the integration of dental care into the primary healthcare (PHC) setting, including oral urgent treatment (OUT). However, the knowledge necessary for OUT implementation in this setting is still limited. Thus, this study aimed to describe the impact of the implementation of oral disease risk assessment tools for oral health management in PHC. Methods This was a cross-sectional study that included individuals served by a single public PHC unit, with integrated oral healthcare teams, located in the south region of the city of São Paulo, Brazil, between April of 2015 and March of 2017. Data were collected from dental records. Three co-primary endpoints: same day treatment offered, first future appointment scheduled fulfilled, and treatment plan completed were compared before and after the implementation of oral disease risk assessment for OUT. Results A total of 1214 individuals that sought OUT, 599 before and 615 after the implementation of oral disease risk assessment for OUT were included in the study. All three co-primary endpoints had significant changes after the implementation of oral disease risk assessment for OUT. Individuals were significantly more likely to be offered same day treatment after (39.9%; 95% CI:36.0–43.9%) than before (9.4%; 95% CI: 7.2–12.0%), to fulfill their first future appointment scheduled after (34.9%; 95% CI:31.1–38.8%) than before (20.7%; 95% CI: 17.5–24.2%), and to have their treatment plan completed after (14.3%; 95% CI:11.6–17.4%) than before (10.0%; 95% CI: 7.7–12.7%) the intervention. Conclusions This study provided evidence of the positive impact oral disease risk assessment tools could have in the organization of OUT in PHC settings.
Problema: O significado de demanda espontânea é a busca dos pacientes por atendimento por sua autopercepção ou por alguma intercorrência clínica. Por muitas vezes, essa porta de entrada é utilizada de maneira recorrente pelos mesmos pacientes, sobrecarregando o serviço sem que eles tenham suas necessidades resolvidas. Métodos: O objetivo deste trabalho transversal e descritivo foi reorganizar de forma equânime o atendimento à demanda espontânea odontológica através da elaboração de instrumento para caracterizar o perfil dos pacientes da Unidade Básica de Saúde Jardim das Palmas, uso da classificação de risco por cores (CAB 28), escala de dor e prioridade clínica odontológica e garantir a continuidade do cuidado destes na atenção básica. Resultados: Tivemos a priorização das urgências, criação de planilha com dados dos 3.640 pacientes que compareceram de abril de 2016 à fevereiro de 2018 à demanda espontânea, além das classificações de risco de cárie, periodontal, tecido mole, oclusão e escala de coelho familiar, para intervenção na vulnerabilidade social destes pela discussão de casos e projetos terapêuticos singulares com equipe multidisciplinar. Através dessas classificações, as agendas dos cirurgiões dentistas foram readequadas para que fosse possível o atendimento das urgências de fato com o aumento dos horários para as vagas de urgência, foi dado acesso ao tratamento odontológico aos pacientes com alta vulnerabilidade social e risco odontológico, e acesso aos grupos de prevenção para os pacientes de baixo risco odontológico. Conclusão: A gestão da demanda espontânea odontológica foi de grande valia para a organização do serviço e maior acesso de forma mais equânime e cuidado longitudinal dos pacientes.
Background: The access to dental health services is a big problem in many parts of the world. The Primary Health Care proposes the organization of the access with equity and it can be done by stratification of risk and scale of vulnerabilities. The aim was to evaluate the impact of the implementation of risk classification tools to improve the access to dental health demand in Primary Health Care and to evaluate the effectiveness of implantation of the tool: risk classification and Coelho and Savassi's scale for organization of dental health service demand in one Primary Health Service in São Paulo city.Method: This was a cross-sectional study in which medical records (n = 1215) were evaluated before and after the implementation of the tool. The outcomes were 'immediate care', 'first dental appointment' and 'treatment completed', the independent variables were risk classification, Coelho and Savassi's scale, caries risk, periodontal disease, soft tissue, age and gender. Descriptive analyzes were performed comparing the variables of the study before and after the implantation of the tools (risk classification and "Coelho and Savassi" scale). Logistic Regression models and chi-square tests were performed to analyze these associations.Results: The most prevalent age group was 20 to 59 years old, 62.2% before and 59.4% after implantation. The main complaint of dental demand was pain. Regarding the "Coelho and Savassi" scale", 87.1% presented low social risk (R1), 8.5% medium risk (R2), 4.2% high risk (R3). The immediate care before implantation was 9.4% (n=56) and 39.9% (n=246) after implantation (p <0.001). The first dental appointment was 20.7% before implantation and 34.9% after the implantation (p <0.001). Regarding the treatment completed, there was an increase from 10% to 14.1% after the implantation of the tools (p = 0.001).Conclusions: The implementation of the tools 'risk classification and "Coelho and Savassi" scale' had impact in organization of odontological demand, with indicated an increase in the number of visits on the same day, first dental appointments and completed treatments. These results reinforce the importance of use of the tools to organize oral health care access. Background 4The access to dental services is still a problem in many places around the world. The ways in which the health systems are organized and social determinants are factors influencing the access to dental services, with effects on the population's oral health [1,2,3] Access is a big challenge in a universal health system, as oral health is necessary to ensure the comprehensiveness of care. Efforts seeking to broaden this access in an equitable manner are essential.In Brazil, for many decades, oral health care was typically sought by pregnant women and children, while other population groups accessed dental care services in emergency situations only, or did not access them [4]. Allied to this, the demographic and epidemiological transition, with population aging the increase in the number of non-communicable chronic disease...
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