Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Department of Dental Clinic, Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
PLoS One. 2020 May 29;15(5):e0233604. doi: 10.1371/journal.pone.0233604. eCollection 2020.
The quality of oral health care might be evaluated based on Donabedian's structure-process-outcome model. This study assessed the association between the oral health public services structure and work process of oral health teams (OHT) and performance indicators (access and problem-solving capacity) in Brazil. Secondary data from a national program obtained through interviews and by observation in 2013/2014 were analyzed. The performance indicators were Coverage of First Scheduled Dental Appointment (FDA) (< or ≥ the mean) and Ratio between Completed Treatments and First Scheduled Dental Appointments (CT/FDA) (< 1 or ≥ 1). The structure was assessed by the sum of available instruments, equipment, and supplies. Latent class analyses were used to identify similar groups (consolidated, developing, and incipient) of OHT according to the work process (planning of actions, health promotion and intersectoral actions, and integral health care). Each OHT was also described regarding the number of the health team in which the OHT operates, whether the primary care unit receives students/teaches, frequency of care provided outside of OHT coverage, and participation in telehealth. Multiple logistic regression models were adjusted for each performance indicator. A total of 16189 (99,8%) and 16192 (99,9%) OHTs located in 4344 (78,0%) municipalities had complete data on the work process and structure. 91.92% of OHTs presenting CT/FDA ≥ 1 and 37.05% presenting FDA ≥ the mean. Consolidated planning of actions and better structural conditions were associated with better performance. A higher frequency of CT/FDA ≥ 1 was observed among OHTs with consolidated integral health care and those that performed telehealth. OHTs that served individuals outside of OHT coverage daily and that worked with two to nine Health Teams presented a higher frequency of FDA ≥ the mean. OHTs with better structural and work process conditions had better performance.
口腔卫生保健质量可以基于 Donabedian 的结构-过程-结果模型进行评估。本研究评估了巴西口腔卫生公共服务结构与口腔卫生团队（OHT）工作流程以及绩效指标（可及性和解决问题能力）之间的关联。本研究通过 2013/2014 年的访谈和观察收集了国家项目的二级数据进行分析。绩效指标为首次预约牙科治疗覆盖率（FDA）（<或≥平均值）和已完成治疗数与首次预约牙科治疗数的比例（CT/FDA）（<1 或≥1）。结构通过可用仪器、设备和用品的总和进行评估。潜在类别分析用于根据工作流程（行动规划、健康促进和跨部门行动以及综合医疗保健）识别 OHT 的相似组（巩固、发展和初始）。还根据 OHT 运作的卫生团队数量、初级保健单位是否接收学生/教学、OHT 覆盖范围外提供护理的频率以及参与远程医疗来描述每个 OHT。对每个绩效指标进行了多项逻辑回归模型调整。共有 16189（99.8%）和 16192（99.9%）个位于 4344 个（78.0%）市的 OHT 具有完整的工作流程和结构数据。91.92%的 OHT 具有 CT/FDA≥1，37.05%的 OHT 具有 FDA≥平均值。巩固的行动规划和更好的结构条件与更好的绩效相关。在具有巩固的综合医疗保健和进行远程医疗的 OHT 中，观察到 CT/FDA≥1 的频率更高。每天为 OHT 覆盖范围之外的个体提供服务且与 2 至 9 个卫生团队合作的 OHT 具有更高的 FDA≥平均值频率。具有更好的结构和工作流程条件的 OHT 具有更好的绩效。
