Predictors of the Demand for Dental Appointments in Primary Health Care: A National Cross-Sectional Study

Abstract

Background Aiming to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide, it is necessary that public dental services act in an integrated manner within the Health System, particularly with the primary care services. However, even inside availability scenarios in health care, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. The aim of the present study was to evaluate the predictors of the demand for dental care in Primary Health Care Units (PHC) with Oral Health Teams (OHTs). Methods The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB, Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user requested a dental appointment at the Health Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome. Results In the final model, of the variables at the individual level, the patient's age over 43 years (OR = 2.03, 95% CI: 1.96–2.10) was the one that had the greatest effect on the outcome. In turn, among the contextual variables related to the teams, the ones with the greatest effect on the outcome were 'oral health teams that assisted no more than a single family health team' (OR = 1.29, 95% CI: 1.23–1.36) or 'those in which the dental form constitutes the user's medical record' (OR = 1.21, 95% CI: 1.15–1.26) were predictors of the demand for a dental appointment in Primary Health Care. Conclusion It can be concluded that individual and contextual issues interfere in the demand for dental care. Oral health planning must consider an active search for patients with profiles that do not favor the spontaneous demand for oral health care, such as being older, male gender and non-white ethnicity. It is also concluded that the oral health teams that worked in line with the Brasil Sorridente guidelines are the teams most often sought after by the users.