Abstract
ObjectiveThis study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance.Material & methodsA mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis.ResultsQuantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services.ConclusionDespite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses.
Highlights
The Item response theory (IRT) analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance Oral Health Teams (OHTs) from other OHTs
Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency
The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in primary health care (PHC) services
Summary
Evidence shows that health systems organized through primary health care (PHC) are more effective and efficient [1,2,3], which has led several countries to seek strategies to expand and strengthen their health systems based on the guiding principles of PHC [3]. Since 1994, Brazil has been strengthening its PHC system through the Family Health Program. In 2016, Family Health Program teams covered around 60% of the Brazilian population. Oral health is still a challenge for Brazilians. In 2003, a national survey showed that 20% of the Brazilian population had already lost all their teeth [4]. In order to reverse this epidemiological picture, Oral Health Teams (OHTs) were included in the Family Health Strategy. By 2016, there were already about 33,000 OHTs in Brazil
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