Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil

Abstract

This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients. The specialties with the highest frequencies were endodontics (68.4%), minor oral surgery (65.8%), periodontics (63.0%), radiology (46.8%), oral medicine (40.2%), orthodontics (20.5%) and implantology (6.2%). In all percentiles, the shortest wait time for secondary care was for radiology, followed by oral medicine and the other specialties. In the 50th percentile, the wait for endodontics, periodontics, minor oral surgery and orthodontics was 30 days, while for implantology, the wait was 60 days. Finally, in the 75th percentile, the wait for endodontics, orthodontics and implantology was 90 days or more. Two clusters, with different frequencies of OHT access to specialties, were identified. Cluster 1 (n = 7,913) included the OHTs with lower frequencies in all specialties except orthodontics and implantology compared with Cluster 2 (n = 4,474). Of the Brazilian regions, the South and Southeast regions had the highest frequencies for Cluster 2, with better rates for the relationship between primary and secondary care. This study suggests certain difficulties in the relationship between primary and secondary care in specific specialties in oral health, with a great number of OHTs with limited access to DSCs, in addition to different performance in terms of OHT access to DSCs across Brazilian regions.

Analysis of the oral health care network development in Minas Gerais state, Brazil

“…Human resources are a fundamental part of the organization and efficient performance of health care networks. It is known that a precarious employment relationship may negatively affect operationalization of networks (1,2,9,12,19). However, in the present study, there was no difference in the health network of oral health coordinators hired through a public application process and those with individual employment contracts.…”

Availability of Dental Prosthesis Procedures in Brazilian Primary Health Care

“…The North has peculiar characteristics, such as the greatest territorial extension and a low population density. This region faces major economic and social challenges [11] and also one of highest needs for dental prostheses [11, 25]. …”

“…According to the results of evaluation of the health teams, they can receive a financial incentive for the continuity of systematic progress. Previous studies based on data from the PMAQ-AB have already evaluated the performance of dental procedures [8, 9] and oral health preventive procedures [10], as well as the interrelation between PHC and specialized care [11]. However, despite financial incentives provided by the Brazilian MS to expand and qualify PHC, no detailed evaluation of the performance of prosthetic procedures has been carried out as yet.…”

Regional differences in infection control conditions in a sample of primary health care services in Brazil

“…For example, if one clinic's score was 8, it meant that this service had met eight infection control criteria. Although the SUS may have geographical differences in the quality of its services 20,21 , for infection control, no previous results have shown any differences. Therefore, we used the multivariate agglomerative hierarchy technique and the between-groups linkage (average linkage) with squared Euclidian distances for the cluster analysis 22 .…”