Abstract
The objective was to compare the presence and extension of primary health care (PHC) in oral health services using the PHC attributes according to three different types of PHC organizational arrangements: Family Health Strategy (FHS), Community Health Service (CHS) and Traditional Primary Care (TPC). This is a cross-sectional study carried out between 2011-2013, following a cluster random sampling strategy. Adult users were interviewed from 15 health services of that 6 were managed by the CHS, 4 by the FHS and 5 by the TPC and which had the same oral health team for at least two years. The final sample was 407 users interviewed using the Primary Care Assessment Tool - Oral Health of Adults evaluation instrument and a sociodemographic questionnaire. PHC scores were calculated and transformed on a scale ranging from 0 to 10. For high scores, the cut-off point > 5.5 was used. Most of the interviewees were females, for the three types of services. The performance of CHS and FHS was higher than those of TPC in almost all attributes (p < 0.05). The extent of PHC attributes in services was poor (overall highest score was 5.75 in CHS). The CHS was the only service witch half of the users (83; 49.1%) rated oral health services as having a high overall score for PHC. It is concluded that there were differences among the organizational arrangements of PHC oral health services, however, there is much to be improved in the orientation of dental care services for PHC. More studies are necessary to evaluate the differences in PHC services considering oral health.
Highlights
Over the course of its history, the Brazilian health system was characterized by a hospital-centered organizational arrangement of care, focused on medical consultation 1
Users of Community Health Service (CHS) had the largest proportion of whites among the services (66.2%) and those of the Traditional Primary Care (TPC) had the lowest proportion of patients who were part of AB classes (19.42%), whereas those of CHS presented 30.53% of patients who fall into this category
Education and income varied as well among the types of primary health care (PHC) services, with mean of years of study 7.47 (SD = 3.46) and 7.74 (SD = 3.43) to individuals from Family Health Strategy (FHS) and TPC respectively and the mean of income was higher in users from CHS (BRL 801.63) and smaller to TPC (BRL 670.82)
Summary
Over the course of its history, the Brazilian health system was characterized by a hospital-centered organizational arrangement of care, focused on medical consultation 1. This type of care, focused on consultation, is characterized as being disease-centered, focused on the diagnosis and treatment, it is biologic, with emphasis on technicality 2. The actions of recovery and rehabilitation of the disease were prioritized, at the expense of health promotion and protection actions 3. Since this organizational arrangement did not consider the improvement of health indicators, it was widely questioned. The transformation of the organizational arrangement of care involves the implementation of changes in the work process, both in relation to its purpose and goals, and to its structural elements 4
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