Celeste Roger Keller, Moura Flávio Renato Reis de, Santos Carolina Paiva, Tovo Maximiano Ferreira
Cad Saude Publica. 2014 Mar;30(3):511-21. doi: 10.1590/0102-311x00011913.
The aim of this study was to describe the production of specialized outpatient dental services and associated factors in Brazilian municipalities (counties) with and without Specialized Dental Clinics (SDC). Data were collected from the following sources: Information Technology Department of the Unified National Health System, Human Development Atlas for Brazil, and Brazilian Institute of Geography and Statistics. Zero-inflated negative binomial regression was used to fit rates of endodontic procedures, primary care, periodontics, and surgery. After controlling for socio-demographic factors, municipalities with SDC showed higher rates for the above-mentioned procedures than those without, except for primary care. In the final model, including service structure variables, municipalities with type III SDC showed a rate of endodontic procedures that was 2.08 times higher (95%CI: 1.26; 3.44) than those without. Among the structural variables, municipalities with higher health expenditures and more dentists in the Unified National Health System showed consistently higher rates for all types of procedures. The SDC appear to have a positive effect on the local production of specialized procedures (especially endodontic), an effect not explained by structural variables.
本研究旨在描述巴西设有和未设有专业牙科诊所（SDC）的市（县）的专科门诊牙科服务的提供情况及相关因素。数据收集自以下来源：统一国家卫生系统信息技术部、巴西人类发展地图集以及巴西地理与统计研究所。采用零膨胀负二项回归来拟合牙髓治疗程序、初级保健、牙周病学和外科手术的发生率。在控制了社会人口因素后，设有SDC的市上述程序的发生率高于未设SDC的市，但初级保健除外。在最终模型中，纳入服务结构变量后，III型SDC市的牙髓治疗程序发生率比未设SDC的市高2.08倍（95%置信区间：1.26；3.44）。在结构变量中，统一国家卫生系统中卫生支出较高且牙医较多的市，所有类型程序的发生率一直较高。SDC似乎对专科程序（尤其是牙髓治疗）的本地提供有积极影响，这种影响无法用结构变量来解释。
