Date Published: May 30, 2019
Publisher: Public Library of Science
Author(s): Clarice Magalhães Rodrigues Reis, Antônio Thomaz Gonzaga Matta-Machado, João Henrique Lara Amaral, Juliana Vaz de Melo Mambrini, Marcos Azeredo Furquim Werneck, Mauro Henrique Nogueira Guimarães de Abreu, Heidi H. Ewen.
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.
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.
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.
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.
Evidence shows that health systems organized through primary health care (PHC) are more effective and efficient [1–3], which has led several countries to seek strategies to expand and strengthen their health systems based on the guiding principles of PHC . Since 1994, Brazil has been strengthening its PHC system through the Family Health Program. In 2016, Family Health Program teams covered around 60% of the Brazilian population.
Despite the theoretical scores could varied from -4 to +4, in this study the scores of OHT performance for all Brazilian OHTs surveyed (n = 12,403) varied from -2.76 to +2.12 (S2 Fig). IRT analysis also shows that OHTs with high performance develop actions to identify oral lesions and referring suspected cases of oral cancer (80.4%) and provide the dentures and follow the patients with documentation (30.1%) more frequently than lowest scores OHTs. So, these two questions had high difficulty parameter value by IRT.
This mixed-methods study showed that most OHTs perform the expected dental procedures in PHC. Procedures related to prostheses and the prevention of oral cancer are performed by a much smaller number of OHTs usually with higher performance.
The results of this mixed-methods research show that, 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. Given the importance of that health condition, public policies should continue addressing oral health care demand. Thus, there is a need to attempt to deliver PHC principles in oral care.