Souza Georgia C, Sousa Lopes Maria Luisa D, Roncalli Ngelo G, Medeiros-Júnior Antonio, Clara-Costa Iris do Céu
Universidade do Estado do Rio Grande do Norte, Natal, Brasil.
Rev Salud Publica (Bogota). 2015 May;17(3):416-428. doi: 10.15446/rsap.v17n3.44305.
Objective Based on the system of reference and counter-reference and comprehensiveness in oral health care, we aimed to examine ways of refering users to Specialized Dental Care Centers (SDCC) and the interface between them and Primary Care. Methods This is a cross-sectional study carried out with users and dentists of SDCC in a metropolitan region of Northeast of Brazil. Analyses were descriptive, and the association test was done with chi-square. Results Six forms of entry to specialized service were identified: free demand (13.8 %) and reference by the Primary Care dentist (63.2 %) were most frequent. Users referred by the basic health unit dentist had more interest in making a counter-reference than the others (p<0.001, PR=4.65, 95 % CI: 2.74 to 7.91), while individuals without this referral had 1.49 times more difficulty obtaining care (95 % CI: 1.02 to 2.17). Referral procedures are a decisive factor for counter-references. However, the high demand for primary care services and the short supply these services can offer in the face of needs make SDCC performance difficult. Conclusion The analysis of oral health practices from the perspective of network modeling points to the service's need to establish protocols for regulation in a bid to improve access to and the quality of care provided.
目的 基于口腔卫生保健中的参照与反参照系统及全面性，我们旨在研究将用户转介至专业牙科护理中心（SDCC）的方式以及这些中心与初级保健之间的衔接。方法 这是一项针对巴西东北部一个大都市地区SDCC的用户和牙医开展的横断面研究。分析采用描述性方法，关联检验采用卡方检验。结果 确定了六种进入专科服务的形式：免费需求（13.8%）和初级保健牙医的转介（63.2%）最为常见。由基本卫生单位牙医转介的用户比其他用户更有兴趣进行反参照（p<0.001，PR=4.65，95%CI：2.74至7.91），而没有这种转介的个体获得护理的困难程度高出1.49倍（95%CI：1.02至2.17）。转介程序是反参照的决定性因素。然而，初级保健服务的高需求以及面对需求时这些服务的供应短缺使得SDCC的运作困难。结论 从网络建模的角度对口腔卫生实践进行分析表明，该服务需要制定监管协议，以改善护理的可及性和所提供护理的质量。
