Acesso aos serviços de saúde bucal na rede de atenção à saúde

Abstract

Background: Background: Despite the significant expansion of oral health services in recent years, access to Primary Health Care (PHC) services and specialized oral health care in Brazil is still selective and exclusive, which can impact the quality of life and in people's survival, if there are problems with access to services for the early diagnosis of oral cancer. Objective: To identify possible changes in the indicators of potential access (structure of health services and the work process of PHC teams) over time (Chapter I), and to analyze the spatial distribution of the supply of specialized cancer care services. mouth (CB) and its spatial correlation with disease mortality rates (Chapter II). Methodology: Chapter I used the transition analysis of latent classes to assess two cross-sections of the external evaluation of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB) (Cycle I: 2011-2012) and (Cycle II: 2013-2014) through eight indicators of structure and work process of PHC teams and elaboration of choropleth maps to describe the distribution of latent transition patterns for Federative Units (UF). In Chapter II, an observational, cross sectional and ecological study of national scope was carried out, which investigated the spatial correlation between the provision of services for diagnosing BC and mortality from the disease between the years 2014 and 2019, using data from the first evaluation cycle of the Program for Improvement of Access and Quality of Dental Specialization Centers (PMAQ-CEO) held in 2014. Choropleth maps were made and Moran Local analysis (alpha = 5%). Results: In chapter I, it was identified that the proportion of PHC establishments that had one or more dentist, dental office and operated at minimum hours increased from 65.56% to 67.13 between the PMAQ-AB cycles. The number of PHC teams that made appointments every day of the week increased by 8.7% and those that made home visits increased by 18.8%. However, there was a reduction in the number of teams that reported guaranteeing an agenda to accommodate spontaneous demand, ranging from 62.41% to 60.11% and in the continuity of treatment, ranging from 63.41% to 61.11%. The spatial distribution of latent transition patterns indicates that the structure of health establishments remained mostly with the status "best completeness" in both cycles in all UFs. In the North region are the FUs with the highest percentage of improvement between cycles, however, in the same region, Pará, Amazonas and Acre presented the highest percentage of PHC establishments that remained worse or that got worse from one cycle to the next. In Article II, it was found that 82.26% of Brazilian CEOs performed a biopsy and 79.14% were able to perform it within 15 days, 76.02% had a reference for the histopathological examination and 57.43% received the report within 30 days. Only 46.88% of CEOs registered cases of BC and 80% had referrals for treatment, with services for diagnosis of CB being offered in 33% of CEOs. A pattern in the formation of clusters (spatial clusters) was identified between the supply of services and mortality by BC between the years evaluated. Clusters “low-low” (areas with less supply of CB services close to areas with lower mortality from CB) and “high-low” (areas with greater offer of services close to areas with lower mortality from CB) (p <0,05) were the most found, mainly in the Center-North and Northwest areas of the country, where we identified the formation of clusters for all the years evaluated. Conclusion: Positive changes were identified in the indicators of access to PHC oral health services, expanding the capacity of use (potential access) of oral health services, however, organizational barriers persist. In specialized care for CB, the limited supply of specialized actions for the diagnosis and detection of the disease may be influencing mortality rates.