CAMINHOS PARA IMPLEMENTAÇÃO DE GUIAS DE PRÁTICA CLÍNICA PARAMANEJO DA CÁRIE DENTÁRIA NA ATENÇÃO PRIMÁRIA À SAÚDE

Abstract

Clinical Practice Guides (GPC) are support tools for clinical decision-making based on scientific evidence. However, they are not well implemented in all Primary Health Care (PHC) settings. The objective was to evaluate the perception of dental surgeons regarding the management of dental caries and the knowledge and practice of GPC by managers (municipal coordinators) and dental surgeons in PHC in the State of Mato Grosso do Sul using the Consolidated Framework for Research of Implementation (CFIR). For qualitative research, semi-structured interviews were carried out with eight key informants, and subsequently, a content analysis and the CFIR domains were used to explain barriers and facilitators. For quantitative research, a questionnaire was applied with sociodemographic characteristics of dentists in the public and private sector, followed by pre-defined questions based on the CFIR domains, plus four questions related to one of the guidelines published by the General Coordination of Oral Health of the Ministry Health. The main barriers were: lack of knowledge about the guides (characteristics of the intervention); resistance to innovation by older professionals (characteristics of individuals); lack of organizational support and incentives (external setting), few resources available to the dentist and lack of readiness for facility (internal setting). The main facilitators were: good connection between the work team and existing communications within the organization (internal scenario); recognition of the need to implement a guide for managing dental caries in PHC (internal scenario), acceptability for the use of GPC (characteristics of individuals); use opinion leaders as facilitators; and the need to improve the quality of services and workflow (work process). Stakeholders recognize the need for minimal intervention in the management of dental caries and support the use of GPC in PHC. However, some challenges must be faced, such as improving access to these documents, facing resistance to innovation on the part of dental professionals, improving the allocation of resources available for professional calibration and promoting readiness for implementation. Some shortcuts can make it easier to overcome these obstacles, such as the use of opinion makers, with the aim of promoting the dissemination of scientific evidence, combined with investment in continuing education through constant training for service professionals. Furthermore, it is desirable that managers recognize who the opinion leaders are to facilitate implementation. The factors that influence the implementation of evidence in clinical practice through Clinical Practice Guides within the PHC Oral Health service could be identified in this research. Studying them contributes to the creation of GPC implementation strategies, to improve the clinical practice of professionals and the health outcomes of patients.

Descriptors: clinical practice guide; dentistry; dental cavity; family health strategy; primary health care.