Abreu Mauro Henrique Nogueira Guimarães de, Amaral João Henrique Lara do, Guimarães Zina Lívia, Vasconcelos Mara, da Silveira Pinto Rafaela, Werneck Marcos Azeredo Furquim
Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Community Dent Oral Epidemiol. 2022 Feb;50(1):19-26. doi: 10.1111/cdoe.12712. Epub 2021 Dec 3.
To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil.
This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ-CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI).
Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01-1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ-CEO result (RR = 1.01 95% CI 1.01-1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01-1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01-1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01-1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02-1.11); those whose team periodically performed self-assessment processes, using the Ministry of Health's formal self-assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02-1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01-1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96-0.99).
Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.
在巴西牙科专科中心（DSC）具有全国代表性的样本中，调查健康管理和人力资源因素与矩阵支持（MS）之间的关联。
本调查纳入了2018年全国牙科专科中心质量提升与可及性计划（葡萄牙语为PMAQ-CEO）第二轮中的1042个DSC（回复率=94.99%）。经过预先培训的访谈者使用结构化工具提取了DSC的MS、健康管理和人力资源方面的信息。通过将10个MS问题的肯定回答数量相加得出MS分数。使用负二项回归模型来估计未调整和调整后的率比（RR）以及相应的95%置信区间（CI）。
在所有DSC（n = 1042）中，116个（11.1%）执行了所有10项MS程序。与参考类别相比，那些拥有在公共卫生或公共管理领域具有高等教育学位的管理人员的DSC（RR = 1.01，95%CI，1.01 - 1.02）以及其人力资源因与PMAQ-CEO结果相关的绩效而获得激励、奖金或财务奖励的DSC（RR = 1.01，95%CI 1.01 - 1.02）更有可能执行MS。更有可能执行MS的DSC包括那些因定期规划和评估并带有确认文件而开展行动的DSC（RR = 1.06，95%CI；1.01 - 1.10）；那些在工作计划的规划和组织方面获得支持的DSC（RR = 1.03，95%CI；1.01 - 1.05）；那些对DSC提供的每个专科设定的目标进行监测和分析的DSC，有（RR = 1.06，95%CI；1.01 - 1.10）或没有确认文件（RR = 1.06，95%CI；1.02 - 1.11）；那些其团队定期使用卫生部正式自我评估（葡萄牙语为AMAQ）进行自我评估过程的DSC（RR = 1.04，95%CI；1.02 - 1.05）；那些遵循关于患者从初级保健转诊到DSC的临床指南（有确认文件）的DSC（RR = 1.02，95%CI；1.01 - 1.04）。相反，那些在DSC团队工作计划的组织中未使用先前PMAQ周期所取得结果的DSC被证明执行MS的可能性较小（RR = 0.98，95%CI；0.96 - 0.99）。
在巴西二级口腔卫生保健中，矩阵支持与人力资源和管理因素相关。持续专业发展和一些管理特征对二级牙科保健质量很重要，可在卫生政策举措中予以考虑。
