RESUMEN
OBJECTIVE: To test the factorial validity and reliability of the Primary Care Assessment Tool adapted to Oral Health, adult patient version, an instrument used to verify the presence and extent of attributes in Primary Health Care services. METHODS: Population-based cross-sectional study using conglomerate random sample carried out in Primary Health Care Dental services in Porto Alegre between 2011 and 2013. We interviewed 407 adult patients who used Primary Health Care Dental services. Construct validity was tested through factorial validity and reliability of the Primary Care Assessment Tool, that comprises 81 items distributed throughout Primary Health Care attributes. Equamax orthogonal rotation method was used in the factorial analysis; and, in order to assess reliability of each component, we used the item-total correlation and the ratio of success of the scale. RESULTS: In the factorial analysis, 10 factors were retained, explaining 53.3% of the total variation. This result demonstrates the multidimensional structure of the instrument. The reliability assessment showed Cronbach's alpha values ranging from 0.39 to 0.89. For the success of the scale most of the results (eight of nine attributes) were greater than 85%. CONCLUSIONS: The instrument is valid for the assessment of oral health services in Primary Health Care from the perspective of adult patients, as well as for monitoring and evaluation of oral health services in Primary Health Care attributes and comparative studies.
Asunto(s)
Servicios de Salud Dental , Encuestas de Atención de la Salud , Atención Primaria de Salud , Adulto , Brasil , Estudios Transversales , Análisis Factorial , Humanos , Reproducibilidad de los ResultadosRESUMEN
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.
Asunto(s)
Servicios de Salud Dental , Atención Primaria de Salud , Adulto , Brasil , Servicios de Salud Comunitaria , Estudios Transversales , Salud de la Familia , Femenino , Humanos , Masculino , Salud BucalRESUMEN
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.
O estudo buscou comparar a presença e abrangência de atributos da atenção primária em saúde (APS) em serviços de saúde bucal, de acordo com três diferentes arranjos organizacionais de APS: Estratégia Saúde da Família (ESF), Serviço de Saúde Comunitária (SSC) e Atenção Primária Tradicional (APT). O estudo transversal foi realizado entre 2011 e 2013, adotando uma estratégia de amostragem aleatória em clusters. Foram entrevistados adultos usuários de 15 serviços de saúde, sendo 6 do SSC, 4 da ESF e 5 da APT, e que mantinham a mesma equipe de saúde bucal há pelo menos dois anos. A amostra final consistiu em 407 usuários, entrevistados com o instrumento Primary Care Assessment Tool - Oral Health of Adults e com um questionário sociodemográfico. As pontuações de APS foram calculadas e transformadas em uma escala de 0 a 10. Para as pontuações altas, foi utilizado o ponto de corte de > 5,5. Nos três tipos de serviços, a maioria dos entrevistados era do sexo feminino. Em quase todos os atributos, o desempenho dos SSC e da ESF foi superior àquele da APT (p < 0,05). A abrangência dos atributos de APS foi baixa (a pontuação mais alta foi 5,75, no SSC). O SSC foi o único serviço em que a metade dos usuários (83; 49,1%) avaliou os serviços de saúde bucal com pontuação geral alta para APS. Conclui-se que havia diferenças entre os arranjos organizacionais de APS nos serviços de saúde bucal, mas há muito a melhorar na orientação dos serviços odontológicos na APS. São necessários mais estudos para avaliar as diferenças nos serviços de APS desde a perspectiva da saúde bucal.
El objetivo era comparar la presencia y extensión de la atención primaria de salud (APS) en cuanto a los servicios orales de salud oral, desde los atributos de la APS, según los tres tipos diferentes de modelos organizativos: Estrategia Salud de la Familia (ESF), Servicios Comunitarios de Salud (SCS) y Atención Primaria Tradicional (APT). Este es un estudio transversal que se llevó a cabo entre 2011-2013, siguiendo una estrategia de muestreo aleatorio por conglomerados. Los usuarios adultos fueron entrevistados en 15 servicios de salud, donde 6 estaban gestionados por SCS, 4 por ESF y 5 por APT y que habían contado con el mismo equipo de salud oral durante al menos dos años. La muestra final fue de 407 usuarios entrevistados, usando la herramienta de evaluación Primary Care Assessment Tool - Oral Health of Adults, así como un cuestionario sociodemográfico. Las puntuaciones de APS se calcularon y transformaron en una escala en un rango de 0 a 10. Para las puntuaciones más altas, se utilizó el punto de corte > 5.5. La mayoría de los entrevistados fueron mujeres en los tres tipos de servicios. El desempeño de los SCS y ESF fue mayor que en la APS en casi todos los atributos (p < 0,05). La extensión de los atributos de la APS en servicios fue escasa (la puntuación general más alta fue 5,75 en SCS). El SCS fue el único servicio con la mitad de usuarios (83; 49,1%) servicios cualificados de salud bucal, contando con una puntuación general alta para APS. Por lo que se concluye que existen diferencias entre los modelos organizativos de APS, respecto a los servicios orales de salud. No obstante, hay muchas cosas que deben ser mejoradas en la orientación de los servicios orales de salud relacionados con la APS. Se necesitan más estudios para evaluar las diferencias en los servicios de APS en relación con la salud bucal.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Atención Primaria de Salud , Servicios de Salud Dental , Brasil , Salud Bucal , Salud de la Familia , Estudios Transversales , Servicios de Salud ComunitariaRESUMEN
ABSTRACT: Objective: To test the factorial validity and reliability of the Primary Care Assessment Tool adapted to Oral Health, adult patient version, an instrument used to verify the presence and extent of attributes in Primary Health Care services. Methods: Population-based cross-sectional study using conglomerate random sample carried out in Primary Health Care Dental services in Porto Alegre between 2011 and 2013. We interviewed 407 adult patients who used Primary Health Care Dental services. Construct validity was tested through factorial validity and reliability of the Primary Care Assessment Tool, that comprises 81 items distributed throughout Primary Health Care attributes. Equamax orthogonal rotation method was used in the factorial analysis; and, in order to assess reliability of each component, we used the item-total correlation and the ratio of success of the scale. Results: In the factorial analysis, 10 factors were retained, explaining 53.3% of the total variation. This result demonstrates the multidimensional structure of the instrument. The reliability assessment showed Cronbach's alpha values ranging from 0.39 to 0.89. For the success of the scale most of the results (eight of nine attributes) were greater than 85%. Conclusions: The instrument is valid for the assessment of oral health services in Primary Health Care from the perspective of adult patients, as well as for monitoring and evaluation of oral health services in Primary Health Care attributes and comparative studies.
RESUMO: Objetivo: Testar a validade fatorial e a confiabilidade do Instrumento de Avaliação da Atenção Básica (Primary Care Assessment Tool - PCATool) adaptado à Saúde Bucal, versão do paciente adulto, que é um instrumento utilizado para verificar a presença e a extensão de atributos nos serviços de Atenção Primária à Saúde. Métodos: Estudo transversal de base populacional, utilizando amostra aleatória de conglomerados realizada nos serviços de Atenção Primária à Saúde Bucal de Porto Alegre entre 2011 e 2013. Foram entrevistados 407 pacientes adultos que utilizavam os serviços de saúde bucal da Atenção Primária à Saúde. A validade de construto foi testada por meio da validade fatorial e confiabilidade do PCATool, que compreende 81 itens distribuídos pelos atributos da Atenção Primária à Saúde. O método de rotação ortogonal Equamax foi utilizado na análise fatorial e, para avaliar a confiabilidade de cada componente, foi utilizada a correlação item-total e a razão de sucesso da escala. Resultados: Na análise fatorial, foram retidos 10 fatores, explicando 53,3% da variação total. Esse resultado demonstra a estrutura multidimensional do instrumento. A avaliação da confiabilidade mostrou valores de alfa de Cronbach variando de 0,39 a 0,89. Para a razão de sucesso da escala, a maioria dos resultados (oito de nove atributos) foi superior a 85%. Conclusão: O instrumento é válido para a avaliação dos serviços de saúde bucal na Atenção Primária à Saúde na perspectiva de pacientes adultos, bem como para o monitoramento e a avaliação dos atributos dos serviços de saúde bucal na Atenção Primária à Saúde e estudos comparativos.
Asunto(s)
Humanos , Adulto , Atención Primaria de Salud , Encuestas de Atención de la Salud , Servicios de Salud Dental , Brasil , Estudios Transversales , Reproducibilidad de los Resultados , Análisis FactorialRESUMEN
The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.
Asunto(s)
Servicios de Salud Dental/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Salud Bucal/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Calidad de Vida , Adulto , Anciano , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Perfil de Impacto de Enfermedad , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Abstract The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Atención Primaria de Salud/estadística & datos numéricos , Calidad de Vida , Salud Bucal/estadística & datos numéricos , Servicios de Salud Dental/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Factores Socioeconómicos , Brasil/epidemiología , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Distribución por Sexo , Perfil de Impacto de Enfermedad , Persona de Mediana EdadRESUMEN
Em função de suas condições socioeconômicas, grandeparte das pessoas dificilmente tem acesso ao acompanhamentoodontológico, ou seja, uma atenção longitudinalem saúde bucal e, consequentemente, não usufrui dasmedidas de prevenção de doenças, acessando o setor deurgência como porta de entrada para o sistema de saúde.Considerando que a procura por consultas de urgência éalta no SSC/GHC e que o acesso ao tratamento muitasvezes é restrito, esse estudo tem como objetivo principaltraçar o perfil do usuário atendido na consulta de urgênciaodontológica da Unidade de Saúde Jardim Itu (USJI), afim de propor estratégias para qualificar o atendimentoodontológico nesta Unidade. O instrumento utilizadopara realizar este estudo foi um questionário contendo16 questões que abordaram dados pessoais e dados sobrea consulta. A partir dos resultados, pode-se concluir quea maioria dos pacientes que procuraram atendimento noserviço de urgência odontológica da USJI eram do sexofeminino, casadas, com idade média de idade de 43 anos,apresentavam baixo nível socioeconômico e baixa escolaridadematerna. A dor de dente foi o principal motivo dasconsultas de urgência e o diagnóstico mais realizado foi ode doença de polpa, mostrando a necessidade da prevençãode doenças bucais, principalmente a cárie.
Because of their socioeconomic status, a large part of the population has no access to longitudinal dental care, thus not being entitled to prevention, and being forced to use the urgency clinics to gain entry to the health system. Taking into account the large number of patients demanding the SSC/GHC, and also the fact that access to treatment is restricted, this study aimed to identify the profile of the users seen at the urgent dental care clinic of the Jardim Itu Health Unit, and propose strategies to improve dental care in the unit. The study consisted of a questionnaire composed of 16 questions on personal data and data on the consultation. Most patients seeking urgent dental care were married women, with a mean age of 43 years, with low socioeconomic level and low maternal schooling. Too-thache was the most frequent complaint, and pulp disease the most frequent diagnosis, pointing to the need of oral disease prevention, chiefly caries