Análise da oferta da especialidade de prótese dentária no centros de especialidades odontológicas brasileiros

Abstract

The need for dental prosthesis (DP) is epidemiologically relevant in Brazil. However, studies addressing factors related to the provision of the Dental Prosthesis Specialty (DPS) associated with the structure and work process have not been found. The general objective of this study was to analyze the provision of DPS in the Dental Specialty Centers (DSCs) in relation to structural and work process aspects. The study is cross-sectional, descriptive, analytical, national, developed in three articles with data from the National Program for Improving Access and Quality of DSCs (PMAQ/DSCs) cycle 2 and production extracted from the Outpatient Information System (SIA) of the Unified Health System (SUS) SIA/SUS. Article1 aimed to identify the provision of DPS in the DSCs participating in the PMAQ/DSCs cycle 2 and characterize them according to structural and work process aspects that may influence the provision. The sample was n=1040; the dependent variable was “offering EPD” and the independent variables addressed “work process” and “structure”. Statistical frequency analyses and a bivariate analysis with p<0.05 were used. Of the CEOs, 61.6% offered PD, characterized themselves and presented an offer influenced by the presence of a manager (95.9%) and without a postgraduate degree in Public Health/Management (56.7%), planned and evaluated actions (84.3%), monitored goals (89.3%), self-evaluated (77%), with attention to absenteeism (77%) and results achieved in previous cycles of the program (57.7%). The offer was more prevalent in “Type 2” CEO (47.1%) and more influenced by Type 3. It was concluded that being Type 3, located outside Higher Education Institutions (HEIs), having a manager, practicing planning, evaluation, monitoring and paying attention to absenteeism and the results of previous cycles of the program were aspects that influenced the offer of EPD. Article2 aimed to verify the association between structural and work process aspects in relation to the offer of EPD in CEO, using the same sample and variables as Article 1. However, the statistical analysis was a logistic regression with a significance level of 5% and a confidence interval of 95%. It was indicated that Type 3 CEOs were 3.78 times more likely to offer EPD (OR = 3.78; 95%CI: 1.90-7.49); those located outside HEIs, 8.40 times more than those inside, OR = 8.40 (95% CI: 1.94; 36.42). CEOs who do not plan and evaluate were 1.83 times less likely to offer EPD, OR = 0.54 (95% CI: 0.35; 0.83), and those participating for the first time, in cycle 2, in relation to participants since Cycle 1 and who use their results in the work process were 2.24 times less likely to offer EPD, OR = 0.44 (95% CI: 0.29; 0.67). It was concluded that Type 3 CEOs located outside HEIs and who carry out periodic planning and evaluation were positively associated with the offer of EPD. Finally, article3 aimed to analyze the association between structural and work process aspects with the production of PD and workload, in CEOs. In this study, in addition to secondary data from PMAQ/CEO cycle 2, data on PD production from SIA/SUS were used. The study sample consisted of 401 CEOs. The dependent variable was the ratio between the average PD delivered and the workload (CH) of dentists (CD) (RZ MPD/MCH) = 0.29. CEOs above the average were dichotomized into “n1” and below, “n0”. The independent variables referred to “work process”, “structure” and “PD production”. Frequency analysis and logistic regression were used. Of the CEOs, 47.8% were characterized as n1 and 52.1% as n0. Services n1 and n0 presented structural and work process characteristics that were practically similar, with differences in the number of sessions for delivery of Total Dentures (PT). n1 had the same number of sessions as recommended by the Ministry of Health, 17.2%, and n0 had 38.8%. Sessions were below the recommended number, n1 had 78.6% and n0 had 56.8%. Not offering Fixed Unitary Prosthesis (FUP) increased the chances of being among n1 by 3.2 and 2 times, respectively, as did having CDs who work in EPD without a master's or doctorate (in any area) by 2.4 times. The lower number of sessions for manufacturing PT and the non-offering of FUP were positively associated with the above-average ratio of prosthesis production by workload. Conclusion of the thesis: Structural and work process aspects favored the offering of EPD. Regarding the factors associated with a higher average production per hour of PD, those that had an influence referred to the work process factor. Given the above, a greater influence of aspects related to the work process in the supply of dental prostheses in the studied CEOs stands out.