[Oral health in the family health strategy in a regional management territory of the state of Piaui]

Disparities in the protagonism of oral health teams in the work process of Primary Healthcare

OBJECTIVE

Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions.

METHODS

Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt's protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators' variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022.

RESULTS

In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the "degree of protagonism of the OHt" in Brazil and macro-regions. The most frequent topics in meetings under OHt's responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator "degree of organization of the OHt concerning case discussion and singular therapeutic projects".

CONCLUSIONS

The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).

Interprofissionalismo na Estratégia Saúde da Família: um olhar sobre as ações de promoção de saúde bucal

Resumo O trabalho interprofissional é necessário para a consolidação do modelo de atenção à saúde, porém o cirurgião-dentista encontra muitos desafios para trabalhar em equipe. Este estudo objetivou conhecer o interprofissionalismo, no âmbito da saúde bucal, entre os trabalhadores graduados da Estratégia Saúde da Família. Tratou-se de um estudo exploratório e transversal, com abordagem qualitativa, desenvolvido com 39 profissionais graduados da Atenção Básica do município de Icó, Ceará, Brasil. Os sujeitos pesquisados declararam uma deficiência na manutenção técnica nas unidades, a recorrente falta de insumos e a demanda excessiva de usuários como elementos que prejudicam o trabalho em equipe, assim como a inexistência de um plano de cargos, carreiras e salários, sendo um motivo de descontentamento entre os profissionais. Todos consideraram importante o trabalho interprofissional e sugeriram reuniões periódicas, atividades compartilhadas mais frequentes e capacitações como forma de intensificar essa ação. Apesar de o trabalho interprofissional ser reconhecido como fundamental para as ações de cuidado, é necessário mais comprometimento e apoio da gestão.

Conhecimento de cirurgiões-dentistas sobre a relação entre disfunção temporomandibular e fatores oclusais

Resumo Introdução As evidências científicas atuais têm demonstrado que o tratamento para disfunção temporomandibular deve seguir uma abordagem conservadora e adaptada ao estado psicossocial do paciente. Entretanto, tratamentos visando às alterações oclusais foram utilizados durante anos pelos cirurgiões-dentistas e o abandono destes paradigmas é essencial para o desenvolvimento da Odontologia. Objetivo Objetivou-se avaliar o conhecimento de cirurgiões-dentistas (CD) sobre a relação entre disfunção temporomandibular (DTM) e fatores oclusais. Material e método Foi enviado, por e-mail, um questionário previamente publicado para os CD registrados no Conselho Regional de Odontologia do Piauí, Brasil (n = 2.500) com dados sobre o profissional, sua formação e seu conhecimento sobre DTM e fatores oclusais. O consenso da literatura atual, “padrão-ouro”, foi comparado com as respostas obtidas. Os dados foram analisados descritivamente e através dos testes qui-quadrado e odds ratio (p<0,05). Resultado Quinhentos e cinco CD responderam e 434 compuseram a amostra. A maioria dos participantes era mulher (72,3%), com 7,2 (±6,63) anos de formados, e trabalhava no setor público-privado (39,0%). Os CD foram divididos em dois grupos: GEsp.: especialistas em DTM, Prótese Dentária e/ou Ortodontia (n=234) e GClín.: clínicos gerais e demais especialistas (n=200). GEsp. e GClín. apresentaram respostas similares para a metade das perguntas. Quatro (de seis) perguntas foram respondidas em desacordo com o padrão-ouro: fatores oclusais, interferências em lado de não trabalho, terapia ortodôntica e ajuste oclusal mostraram ser assuntos pouco conhecidos. GEsp. apresentou maior conhecimento com diferença significativa em relação a GClín. acerca da DTM e das interferências oclusais [odds ratio = 2,341 (1,305-4,202), p=0,004]. Conclusão Pode-se concluir que os CD da amostra estudada apresentaram deficiências acerca do conhecimento da relação entre DTM e fatores oclusais. Especialistas em DTM, Prótese Dentária e/ou Ortodontia não demonstraram um maior nível de conhecimento quando comparados aos demais.

Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review

This is an integrative review that aimed to analyze the performance of the oral health team in home care within the Family Health Strategy, after the publication of the National Oral Health Policy Guidelines. Databases PubMed, Lilacs and SciELO were used in the 2004-2018 period. The selected papers (n=17) were organized in Excel sheet with data: author, year of publication, title, objectives, publishing journal, study location, type of study and thematic category. Two categories emerged from the thematic analysis: "Oral health practices in the household context and the work process of the oral health team" (n=11) and "Instruments for the management and evaluation of home care by the oral health team" (n=6). The scientific production showed low frequency of home visits, lack of prioritization and systematization of home care actions and weak interaction with the family health team. The home care protocols and instruments for the prioritization of home visits indicate the potential to overcome the clinical approach restricted to the dental office. Fourteen years into the publication of the National Oral Health Policy guidelines, the household is a territory to be conquered by the oral health team.

[Dialogues on the work process in oral health in Brazil: an analysis based on the PMAQ-AB survey]

The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.

Advances and challenges in oral health after a decade of the "Smiling Brazil" Program

OBJECTIVE

To analyze oral health work changes in primary health care after Brazil's National Oral Health Policy Guidelines were released.

METHODS

A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care.

RESULTS

Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people's participation and social control; and intersectorial actions.

CONCLUSIONS

Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.