Abstract
ABSTRACTOBJECTIVE:To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size.METHODS:Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size.RESULTS:Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing.CONCLUSIONS:The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.
Highlights
The implementation of the Family Health Program in 1994 and its consolidation by the Family Health Strategy and the National Primary Care policy has shifted the primary health care model in the Brazilian Unified Health System (SUS)[1]
Municipalities with low Municipal Human Development Index (MHDI) presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI
The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time
Summary
The implementation of the Family Health Program in 1994 and its consolidation by the Family Health Strategy and the National Primary Care policy has shifted the primary health care model in the Brazilian Unified Health System (SUS)[1]. In 2000, the Family Health Strategy incorporated oral health care in the Primary Health Care approach. The National Oral Health Policy was instituted in 2004, expanding health care coverage and increasing the access to health promotion and disease prevention actions, aiming to modify the traditional curative-rehabilitative model, based on the principles of health care equity, integrality, and universality[2]. Indicators are measures that summarize information about the efficiency and effectiveness of health systems[4]. Indicators may guide managers’ decision-making allowing the consolidation, reorganization, or qualification of actions[5,6]
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