ANÁLISE DAS AÇÕES DE APOIO MATRICIAL EM CENTROS DE ESPECIALIDADES ODONTOLÓGICAS BRASILEIROS EM INTERFACE COM A ATENÇÃO PRIMÁRIA À SAÚDE BUCAL

Abstract

The National Oral Health Policy (PNSB) was implemented in 2004, assuming an important role in Primary Health Care (PHC), aiming at strategies to reduce oral health inequalities at this level of care and expanding access to specialized treatments through the creation of Dental Specialties Centers (CEO). However, these centers still face challenges and show weaknesses in certain situations, especially concerning the comprehensiveness of care, which depends on interaction with professionals from other levels of care and can be achieved through Matrix Support (AM). This was one of the aspects evaluated by the Program for Quality Improvement and Access to Dental Specialties Centers (PMAQ-CEO). The objective of this study was to investigate whether there is an association between the AM performed in specialized oral health care in the Unified Health System and aspects of integrated work processes with Primary Health Care and contextual variables. The methodological design of the study is of an analytical quantitative nature with a cross-sectional delineation. Secondary data from the External Evaluation of the second PMAQ-CEO cycle, related to Module II, were analyzed. Contextual variables were selected from the Department of Informatics of the Unified Health System and through consultation with the Institute of Applied Economic Research and the Brazilian Institute of Geography and Statistics. Descriptive analyses were conducted, and the variables "oral health coverage in the Family Health Strategy" and the "Gini index" were dichotomized using the median, classifying municipalities with lower and higher coverage and with lower and higher Gini index. Next, four multiple models were adjusted. Model 1 (empty model), Model 2 (individual CEO variables), Model 3 (significant CEO variables), and Model 4 (including contextual variables). From the models, crude and adjusted odds ratios were estimated, along with their respective 95% confidence intervals. The results showed that approximately half of the CEOs did not carry out therapeutic projects built with Primary Oral Health Care teams. It was found that the lack of therapeutic projects built with the teams was associated with a lack of discussion of complex cases by the team, a lack of discussion of individual therapeutic projects, absence of joint continuing education activities, a lack of construction and discussion of clinical protocols, and a lack of belief in the importance of planning and periodic evaluation. The results suggest that the coordination between Primary Health Care and secondary oral health care still presents weaknesses within the Unified Health System (SUS). The comprehensiveness of care needs to be strengthened, demanding greater intervention from management. It was concluded that factors related to the internal functioning of the CEOs have a greater influence on the lack of integration between the Primary Oral Health Care teams, compared to contextual variables of the municipalities. These findings highlight the need to strengthen collaboration and communication between CEOs and the Oral Health teams of the FHS (Family Health Strategy) in order to promote more integrated and effective dental care for SUS users. Descriptors: Secondary Health Care, Health Care Completeness, Family Health Strategy.