Understanding oral health care team performance in primary care: A mixed-method study

Abstract

Objective This study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance. Material & methods A mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis. Results Quantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services. Conclusion Despite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses.

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

“…Other studies have revealed lacunas in the work process of the teams [ 26 , 35 , 51 , 58 ], but our research identifies alarming data, i.e., the increase in the prevalence of PHC teams with “worse completeness” in Cycle II, representing an increase in the proportion of teams that do not perform any of the work processes indicators surveyed, is considered a serious barrier to potential access to oral health services.…”

“…Thus, precarious conditions and inadequacies related to the structure of oral health facilities may cause limitations and difficulties in the use of these services by the community [ 5 , 50 ]. With these limitations, human resources management is considered an essential factor in the provision of quality health services [ 49 , 51 ].…”

“…In addition, studies have revealed that the lack of oral health professionals compromises the work performed in the primary care and limits the access of users [ 52 , 53 ], increasing the demand in hospitals, specialized services, and in urgency and emergency networks due to the low resolvability of this level of care, which does not satisfy the PHC principle of functioning as a gateway to the health system and being an organizer of health care networks [ 51 ].…”

“…Data referring to the work process module in both cycles of the PMAQ-AB were sampled by self-adherence. There are indications that the best-structured teams were those who joined the program [ 51 ], thus inflating the results. However, adherence during Cycle II increased significantly, including units with more considerable variability, and therefore better reflecting the local reality of the health facilities evaluated.…”

A Description of Infection Control Structure in Primary Dental Health Care, Brazil

“…OHT are composed by one dentist and one or two dental assistants. OHT provide community actions and surgical, restorative, preventive procedures at PHC level [ 1 ]. Each PHC unit is evaluated and monitored based on the observation of the facilities, health indicators, and interviews with service users and human resources at PHC.…”