Processo de Trabalho de Equipes de Saúde Bucal do Brasil: desigualdades regionais demonstradas pelo PMAQ-AB

Abstract

ABSTRACT The Family Health Strategy (FHS) emerged with the aim of reorganizing the health work process at the level of Primary Health Care (PHC). In this restructuring, the Oral Health Team (OHT) has an important role in the changes within the health services, as it represents the possibility of breaking away from the care models in oral health based on curative and individual aspects, giving rise to a dentistry articulated with the health surveillance proposals. Understanding how the health work process takes place allows us to understand the health conditions of the population and, based on this understanding, make changes, if necessary, to change the health scenario of the community. The objective of this work was to evaluate the regional differences in the work process of OHT in Brazil. A cross-sectional exploratory and analytical study of national scope was carried out. Secondary data came from OHT that joined the National Program for Improving Access and Quality of Primary Care (PMAQ-AB), and that answered the external evaluation questionnaire. The variables used to analyze the OHT's work process were selected from sub-dimensions present in the score matrix for certification of health teams, which are composed of quality standards, which are the questions asked in the external evaluation. The Municipal Human Development Index (HDI-M), per capita income and state population were the socioeconomic variables used. To compare the work process between the country's geopolitical regions, the one-way ANOVA test was used, followed by the Tukey post test. To analyze the correlation between the work process and the variables HDI, per capita income and state population, Pearson's linear correlation test was used. Statistical analysis was performed using the SPSS statistical program, version 23.0, with a significance level of 5%. Data from 22,993 eSB from 4,813 Brazilian municipalities were analyzed. There was a significant difference between the regions of the country, in relation to the percentage evaluation of all subdimensions evaluated in this study (p<0.001). There was a positive and moderate significant linear correlation in the subdimensions: “Organization of medical records at the UBS” and the variables HDI (p=0.020; r=0.445) and per capita income of the state (p=0.007; r=0.509); “Planning the actions of the primary care team” and the HDI variables (p=0.046; r=0.387) and per capita income of the state (p=0.018; r=0.451); “Service supply” and the variables per capita income (p=0.046; r=0.387) and state population (p=0.021; r=0.442); “Institutional support and matrix support for primary care teams” with the state's per capita income (p=0.039; r=0.400); “Total assessment and per capita income of the state (p=0.041; r=0.397). The results of this study indicated that there is heterogeneity in the work process of eSBs in Brazil, when compared between the country's geopolitical regions. In addition, the HDI, per capita income and population variables are positively correlated with actions in oral health, thus evidencing inter-regional inequalities, unfavorable to socially disadvantaged regions.

Keywords: Primary Health Care, Family Health Strategy, Public Health Administration, Socioeconomic factors, Oral health.