Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis.

Abstract

Objective

Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services.

Methods

Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011-2012 and Cycle II: 2013-2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made.

Results

The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was "Best completeness" in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with "Best completeness" increased by 89.1%, the one with "Worst completeness" increased by 20%, while those with "Average completeness" decreased by 66.3%.

Conclusion

We identified positive changes in the indicators of potential access to oral health services, expanding the users' ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.

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Citation

Published Version (Please cite this version)

10.1371/journal.pone.0247101

Publication Info

Ribeiro, Ana Graziela Araujo, Rafiza Félix Marão Martins, João Ricardo Nickenig Vissoci, Núbia Cristina da Silva, Thiago Augusto Hernandes Rocha, Rejane Christine de Sousa Queiroz, Aline Sampieri Tonello, Catherine A Staton, et al. (2021). Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis. PloS one, 16(3). p. e0247101. 10.1371/journal.pone.0247101 Retrieved from https://hdl.handle.net/10161/22741.

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Scholars@Duke

Staton

Catherine Ann Staton

Professor of Emergency Medicine

Catherine Staton MD MSc

Dr. Staton is a Professor in Emergency Medicine (EM), Neurosurgery & Global Health with tenure at Duke University. She is the Director of the GEMINI (Global EM Innovation & Implementation) Research Center and the EM Vice Chair of Research Strategy & Faculty Development. Her research integrates innovative implementation methods into health systems globally to improve access to acute care. In 2012, with an injury registry at Kilimanjaro Christian Medical Center, Tanzania Dr. Staton demonstrated 30% of injury patients had at risk alcohol use, providing preliminary data for a K01/Career Development Award. Her K01 award adapted a brief alcohol intervention to the KCMC ED and Swahili. This intervention has been proven to reduce 26 binge drinking events per year compared to usual care, and the team is now planning for regional implementation. Dr. Staton and her mentor and collaborator Dr. Mmbaga are co-PD of the “The TReCK Program: Trauma Research Capacity Building in Kilimanjaro” to train 12 masters and doctoral learners to conduct innovative implementation and data science projects to improve care for injury patients. Currently, Dr. Staton and GEMINI partners with over a dozen faculty from over 6 low- and middle-income countries to conduct research, has mentored over 150 learners from undergraduate to post-doctoral levels from high, middle and low- income settings and has over 160 manuscripts.


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