School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
Int J Environ Res Public Health. 2023 Mar 14;20(6):5104. doi: 10.3390/ijerph20065104.
This cross-sectional analytical study assessed the frequency of avoided referrals of primary care to other care levels by dental teleconsulting and its association with individual and contextual variables using a multilevel approach. It appraised asynchronous dental teleconsulting sessions from the secondary database of the Monitoring and Evaluation System of the Telehealth Results during 2020, during the COVID-19 pandemic. The outcome was "whether referral to secondary care was avoided". Individual variables were related to teleconsulting and professionals that requested it: sex, dental specialty, and dentistry field. Contextual variables were related to each municipality that requested responses: Municipal Human Development Index, oral health teams (OHTs) in primary health care coverage, dental specialty centers coverage, illiteracy rate, Gini index, longevity, and per capita income. A descriptive analysis was made using the Statistical Package for the Social Sciences. Hierarchical Linear and Nonlinear Modeling software was used to perform multilevel analyses to assess the association of individual and contextual variables with avoiding patient referral to other care levels. Most teleconsulting sessions avoided patient referral to other care levels (65.1%). Contextual variables explained 44.23% of the variance in the outcome. Female dentists were more likely to avoid patient referrals than male dentists (OR = 1.74; CI = 0.99-3.44; = 0.055). In addition, an increase of one percentage point in OHT/PHC coverage of municipalities increased the likelihood of avoiding patient referral by 1% (OR = 1.01; CI = 1.00-1.02; = 0.02). Teleconsulting sessions efficiently avoided patient referral to other care levels. Both contextual and individual factors were associated with avoided referrals by teleconsulting sessions.
本横断面分析研究采用多水平方法评估了牙科远程咨询避免初级保健向其他医疗级别转诊的频率及其与个体和环境变量的相关性。它评估了 2020 年 COVID-19 大流行期间远程医疗结果监测和评估系统二级数据库中的异步牙科远程咨询会话。结果是“是否避免向二级保健转诊”。个体变量与远程咨询和请求它的专业人员有关：性别、牙科专业和牙科领域。环境变量与请求回复的每个市镇有关：市镇人类发展指数、初级保健中口腔保健团队的覆盖情况、牙科专业中心的覆盖情况、文盲率、基尼指数、预期寿命和人均收入。使用社会科学统计软件包进行描述性分析。使用分层线性和非线性建模软件进行多水平分析，以评估个体和环境变量与避免患者向其他医疗级别转诊的相关性。大多数远程咨询会议避免了患者向其他医疗级别转诊（65.1%）。环境变量解释了结果的 44.23%的变异性。女牙医比男牙医更有可能避免患者转诊（OR = 1.74；CI = 0.99-3.44； = 0.055）。此外，市镇中口腔保健团队/初级保健覆盖增加一个百分点，避免患者转诊的可能性增加 1%（OR = 1.01；CI = 1.00-1.02； = 0.02）。远程咨询会议有效地避免了患者向其他医疗级别转诊。个体和环境因素都与远程咨询会议避免转诊有关。
