Efeitos da pandemia da COVID-19 em indicadores de saúde bucal da Atenção Primária à Saúde no Maranhão

Abstract

Objective: To analyze indicators of use of oral health services (USSB) of Primary Health Care (PHC) in Maranhão, before and during the COVID-19 pandemic. Methods: An interrupted time series ecological study was carried out whose unit of analysis was Maranhão. The exposure variable was the COVID-19 pandemic, dichotomized into pre pandemic (Jan/2015 to Mar/2020) and pandemic (Apr/2020 to Jun/2021), considering the first case of the disease in the state. Data were taken from epidemiological bulletins available on portals of the State Health Department of Maranhão. The outcome variables were calculated by the ratio between the number of procedures related to disease prevention and health promotion (RPP-APS), urgency (RPU-APS) and Curative procedures (RPC-APS), and the census projection of the population of the state, multiplied by one thousand, monthly. The numerator data came from the Health Information System for Primary Care, and the denominator data from the Brazilian Institute of Geography and Statistics. Different autoregressive, integrated and seasonally moving average (SARIMA) models were tested (α=5%), the ones with the best fit were selected based on the criterion of parsimony of AIC (Akaike Information Criterion), BIC (Bayesian Information Criterion), MAPE (Mean Absolute Percentage Error), RMSE (Root Mean Squared Error) and the Ljung-Box and Box-Pierce tests. Results: The autoregressive, integrated and seasonally moving average (SARIMA) models with the best adjustments were: (0.1.0) (1.0.0) in the RPP-APS; (2.1.0) (1.0.0) in RPU-APS; and (0.1.0) (1.0.0) in RPC-APS. The pandemic caused a significant reduction in preventive procedures (Xreg=-6.52; p-value=0.0004) and in dressings (Xreg=-5.18; p value=0.0004). Although there was also a reduction in emergency procedures, there was no statistical difference in this indicator Xreg=-0,03; p-valor=0,1507). Conclusion: The COVID-19 pandemic had an impact on the reduction in the use of preventive and curative oral health services in PHC in Maranhão; and the actions taken in the state were not able to mitigate such effects until the first half of 2021. Constant discussion is recommended about the strategies that must be maintained and the necessary adjustments so that health units are adapted during the pandemic, in case of new waves, and, in the future, in the post-pandemic period.