Master's Degree Program in Family Health, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Brazil.
Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo, Brazil.
BMC Health Serv Res. 2024 Oct 3;24(1):1176. doi: 10.1186/s12913-024-11574-z.
Matrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care.
The aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables.
A quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables.
The results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management.
It was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities.
矩阵支持（MS）是一种可以用于改善基层医疗保健（PHC）与其他护理层级之间整合的策略。
本研究旨在调查巴西牙科专业中心（CEO）（二级口腔保健）实施的 MS 与 PHC 综合工作流程以及情境变量之间的关联。
采用定量的横断面研究方法，利用质量改进和 CEO 准入计划（PMAQ-CEO）的研究数据。对 PMAQ-CEO 第二周期外部评估的二级数据进行了分析，包括从统一卫生系统（SUS）和官方研究机构等来源获得的情境变量。进行了描述性分析，并调整了四个多元模型以调查变量之间的关联。
结果表明，大约一半的 CEO 没有开展与 PHC 口腔卫生团队合作制定的治疗项目。发现与团队合作制定的治疗项目缺失相关的因素有：团队缺乏对复杂病例的讨论、缺乏对个别治疗项目的讨论、没有联合继续教育培训活动、没有制定和讨论临床方案以及缺乏对规划和定期评估重要性的信任。结果表明，在 SUS 范围内，PHC 和二级口腔卫生保健之间的联系仍然存在薄弱环节。需要加强全面护理，需要管理层更多的干预。
与工作流程相关的 CEO 个体因素对与 PHC 口腔卫生团队缺乏整合的影响大于市县级别的情境变量。
