Public oral health services performance in Brazil: Influence of the work process and service structure

Abstract

The quality of oral health care might be evaluated based on Donabedian's structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or � the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or � 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA � 1 and 37.05% presenting FDA � the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA � 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA � the mean. OHTs with better structural and work process conditions had better performance.

User satisfaction with the secondary dental care services: Is there an association between structure and work process?

“…The findings showed that users were satisfied with the services in the presence of better conditions of the structure, considering the availability of a greater amount of equipment and items of ambience. Although oral health service is not restricted to the structural component, several studies have demonstrated a positive relationship among the amount of equipment, the dental appointments provided and the problem‐solving capacity of the CEO 21,29,30 . As previously observed, in this study, user satisfaction was associated with the existence of a higher number of items of equipment in conditions of use in CEOs, 31 which was similar regarding the presence of items of ambience that constituted safe and welcoming spaces 5,29,32 .…”

“…Although oral health service is not restricted to the structural component, several studies have demonstrated a positive relationship among the amount of equipment, the dental appointments provided and the problem-solving capacity of the CEO. 21,29,30 As previously observed, in this study, user satisfaction was associated with the existence of a higher number of items of equipment in conditions of use in CEOs, 31 which was similar regarding the presence of items of ambience that constituted safe and welcoming spaces. 5,29,32 Environments with these characteristics can favour the relationships between professionals and users, making health care more welcoming, resolutive and human.…”

“…The result represents the effects of care on one's state of health, including the level of knowledge, behaviour and user satisfaction 14,15 . Although many studies that evaluate oral healthcare services refer to the Donabedian conceptual model, 2,17,18 few evaluate the three dimensions of quality and their relationships with user satisfaction 19‐21 …”

“…14,15 Although many studies that evaluate oral healthcare services refer to the Donabedian conceptual model, 2,17,18 few evaluate the three dimensions of quality and their relationships with user satisfaction. [19][20][21] The conceptual theoretical model of this study was based on Donabedian 15 and Swan et al, 22 considering the process, structure and result in the assessment of the quality of health services (Figure 1). 15 This nationwide study is based on secondary data from two evaluation cycles of all Brazilian CEOs, conducted in 2014 (cycle 1) and 2018 (cycle 2).…”

Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

“…For the structure of the health units, variables were selected that reflected elements of human resources, physical structure and organizational structure [ 17 , 33 , 34 ]. For the work process, variables related to the organization of the agenda were selected in order to allow access to the first consultation and the continuity of treatment [ 35 – 37 ], as well as the provision of various health services in the dental office and at home [ 38 , 39 ].…”