Monitoring of oral health teams after National Primary Care Policy 2017

ABSTRACT OBJECTIVE To monitor the number of oral health teams implemented in the Family Health Strategy after National Primary Care Policy 2017. METHODS This is a study of quantitative, descriptive and analytical nature that used the data from the public reports of the history of oral health coverage available in the e-Manager platform of Primary Care of the Ministry of Health of all Brazilian municipalities (5,570). The survival rate of the municipalities that did not reduce the number of oral health teams was analyzed according to the region of the country, human development index, Gini inequality index and population size. Cox regression was used to analyze the factors associated with the decrease in the number of teams implanted after 1, 3, 6, 9, 12, 15, 18 and 21 months of publication of the 2017 national policy ordinance, considering the hazard ratio (HR) and p < 0.05. RESULTS After 21 months of publication of the policy, 6.7% of Brazilian municipalities reduced the number of oral health teams. This reduction was higher in the South (6.7%) and Northeast (4.8%), in municipalities with the highest human development index, i.e., greater than or equal to 0.7 (5.6%), more unequal in terms of income distribution (Gini index > 0.62) and larger population size (more than 100,000 inhabitants). Municipalities in the Northeast (HR = 1.220) and South (HR = 1.771) regions had a higher chance of reducing the number of teams compared with those in the North region. More unequal municipalities (HR = 6.405) and with larger population size (HR = 4.273) were also more likely to reduce the coverage of oral health teams. CONCLUSION The municipalities that reduced the number of oral health teams in the Family Health Strategy are from the South and Northeast regions, with greater social inequality and larger population size. This scenario can significantly affect the population’s access to dental health services in the Unified Health System, especially among those in need.

摘要 研究目的：本研究旨在监测2017年国家基层医疗政策出台后，家庭健康策略（Family Health Strategy）中部署的口腔健康团队数量变化情况。研究方法：本研究为定量描述分析类研究，数据来源于巴西全国5570个市镇的基层医疗电子管理（e-Manager）平台中公开的口腔健康覆盖历史报告。本研究按巴西地域分区、人类发展指数、基尼不平等指数以及人口规模，对未减少口腔健康团队数量的市镇的生存率进行了分析；并采用考克斯回归（Cox regression）模型，以危险比（HR）及P<0.05为检验标准，分析2017年国家基层医疗政策法令发布后1、3、6、9、12、15、18及21个月时，与口腔健康团队部署数量减少相关的影响因素。研究结果：政策发布21个月后，巴西共有6.7%的市镇减少了口腔健康团队的部署数量。其中南部地区（6.7%）、东北部地区（4.8%），人类发展指数≥0.7的高发展水平市镇（5.6%），收入分配更不平等（基尼指数>0.62）以及人口规模较大（超过10万居民）的市镇，团队数量减少的比例更高。与北部地区市镇相比，东北部（HR=1.220）和南部（HR=1.771）地区的市镇减少口腔健康团队数量的风险更高。收入分配更不平等的市镇（HR=6.405）以及人口规模更大的市镇（HR=4.273），其口腔健康服务覆盖规模缩减的可能性也显著更高。研究结论：参与家庭健康策略、并缩减了口腔健康团队数量的市镇，均来自南部与东北部地区，且普遍存在社会不平等程度更高、人口规模更大的特征。该现状可能会显著影响民众在巴西统一卫生系统（Unified Health System）中获取口腔医疗服务的可及性，尤其是对有就医需求的人群而言。