Challenges related to dental prosthesis offer in the public health system

Abstract Objective To describe the challenges faced by local health managers during the implementation and maintenance of Regional Laboratories Dental Prosthetics (RLDP), and identify the profile of the cities with RLDP. Method A cross-sectional study using a questionnaire that was replied by 317 local health managers between 2014 and 2015 and information extracted from official database. A chi-square test was used to analyze secondary data, with the existence of credentialed RLDP as a dependent variable and the coverage of Dental Health Team (DHT), local population, Human Development Indices (HDI), Allocation Factor (AF) and data about local health managers being the co-variables. Result The low number of dental prosthetic technician was the main challenge regarding the implementation of the RLDP and low funding was the main one related to maintenance. Cities a population of less than 10,000 inhabitants were more likely to have a credentialed RLDP (rate = 2.42). Conclusion To meet the challenges faced by cities in offering dental prosthesis in the public health, the system demands actions that go beyond the local public sphere. The educational institutions' involvement is needed in order to meet human-resources training requirements and state and federal levels involvement is required to promote strategies that reduce costs and increase access to RLDP by small cities.

摘要 研究目的：旨在描述地方卫生管理者在实施与维护区域牙科修复实验室（Regional Laboratories Dental Prosthetics, RLDP）过程中面临的挑战，并明确设置该类实验室的城市特征。研究方法：本研究为横断面研究，采用问卷调查结合官方数据库信息提取的研究方案：于2014至2015年间共回收317份地方卫生管理者填写的有效问卷，同时从官方数据库中提取相关数据。以是否设立具备资质的RLDP作为因变量，以牙科健康团队（Dental Health Team, DHT）覆盖率、本地人口规模、人类发展指数（Human Development Indices, HDI）、分配系数（Allocation Factor, AF）及地方卫生管理者相关信息作为协变量，采用卡方检验对二级数据开展分析。研究结果：牙科修复技师数量不足是RLDP实施阶段的主要挑战，而经费短缺则是维护环节的核心难题。人口不足1万的城市，其设立具备资质RLDP的可能性更高（比值率为2.42）。研究结论：为应对各城市在公共卫生体系中提供牙科修复服务时面临的困境，现有体系需突破地方公共部门的范畴。需引入教育机构参与以满足人力资源培训的需求，同时推动州级与联邦层面的介入，制定相关策略以降低成本，并提升小城市获取RLDP服务的可及性。