Factors associated with the use of a public information system of dentist-prescribed antibiotics in Minas Gerais, Brazil

Santos, Jacqueline Silva; Cruz, Alex Junio Silva; Ruas, Cristina Mariano; Pereira Júnior, Edmilson Antônio; Mattos, Flávio Freitas; Klevens, Monina; Abreu, Mauro Henrique Nogueira Guimarães

doi:10.1590/1413-81232022279.07422022

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FREE THEMES • Ciênc. saúde coletiva 27 (09) • Sept 2022 • https://doi.org/10.1590/1413-81232022279.07422022 copy

Factors associated with the use of a public information system of dentist-prescribed antibiotics in Minas Gerais, Brazil

Fatores associados ao uso de um sistema de informação público de antibióticos prescritos por cirurgiões-dentistas em Minas Gerais, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to investigate the association between socioeconomic factors, health care organizations, and the use of a management and monitoring system for the dispensing of antibiotics prescribed by dentists in public health services in Minas Gerais, Brazil. This is an ecological-epidemiological study that analyzed secondary data from the Integrated Pharmaceutical Care Management System (SIGAF) of the Department of Health of the state of MG, Brazil, in 2017. Thirteen independent variables were analyzed to assess their influence on municipal adherence to SIGAF system considering dental prescriptions of antibiotics. Descriptive statistical analyses were performed, and the Classification and Regression Tree technique was used to identify the municipal variables associated with the outcome. A total of 57,279 antibiotic courses prescribed by dentists and recorded in SIGAF were examined. Socioeconomic factors were not associated with the use of SIGAF to record these prescriptions. Oral healthcare coverage was positively associated with the use of SIGAF for the dispensing of antibiotics prescribed by dentists. Dental Specialties Center were negatively associated with the outcome. Municipalities with high oral healthcare coverage and those without a Dental Specialties Center were more likely to use SIGAF.

Key words:
Prescription Drug Monitoring Programs; Anti-Bacterial Agents; Dental Care

Independent variables	Definition	Year	Source
Municipality Type	Classification of rural and urban areas in municipalities	2017	IBGE
Dental Specialties Center	Municipality that has one or more health establishments with specialized outpatient dental service accredited by the Ministry of Health as a secondary care unit in the Oral Healthcare Network	2017	Ministry of Health
Rural population rate	Measures the percent of rural population in relation to the total population of the municipality. Formula: (Total rural population)/(total population of the municipality)	2010	DATASUS
Gini Index	Measure of income inequality in a society. Ranges from 0 to 1, with 1 corresponding to maximum inequality	2010	DATASUS
Human development Index	Measure composed of three indicators of a population: longevity, education, and income. Ranges from 0 to 1, with higher values indicating greater human development	2010	Atlas of Human Development
Number of families served by the Bolsa Família Program per 1,000 inhabitants	Measures the rate of families assisted by the income transfer program, Bolsa Família, in relation to the total population. Formula:(Number of families under the Bolsa Família Program x 1,000 inhabitants)/(total population of the municipality)	2017	Ministry of Cities
Dentists who work at BNHS per 1,000 inhabitants	Measures the rate of dentists working in the BNHS per 1,000 inhabitants. Formula: (Number of dentists in the BNHS x 1,000 inhabitants)/(total population of the municipality)	2017	DATASUS
Oral Health Teams type I per 1,000 inhabitants	Measures the rate of teams composed of one dentist and one oral health assistant or technician who work in the Family Health Strategy per 1,000 inhabitants. Formula: (Number of teams modality I x 1000 inhabitants)/(total population of the municipality)	2017	DATASUS
Oral Health Teams type II per 1,000 inhabitants	Measures the rate of teams composed of one dentist, one oral health technician, and one oral health assistant or technician who work in the Family Health Strategy per 1,000 inhabitants. Formula: (Number of teams modality II x 1000 inhabitants)/(total population of the municipality)	2017	DATASUS
Percentage of population covered in oral health in the Family Health Strategy	Measures the population’s access to oral health services that have oral health teams in the Family Health Strategy. It is estimated that each oral health team must cover 3,450 inhabitants. Formula: Number of oral health teams in the Family Health Strategy x 3,450 x 100)/(total population of the municipality)	2017	e-Gestor
Oral healthcare coverage	Percentage of the population with access to oral health services considering the oral health teams in the Family Health Strategy and teams allocated to other primary health care. Formula:	2017	e-Gestor
Coverage of first dental appointment	Percentage of the population that received, in the last 12 months, an assessment of general health conditions and oral clinical examination for the purpose of diagnosis and development of a preventive-therapeutic treatment plan. Formula: (Number of first dental appointments x 100)/(total population of the municipality)	2017	DATASUS
Percentage of preventive and restorative procedures	Percentage of preventive and restorative dental procedures in relation to the total number of dental procedures performed. Formula: (Number of individual preventive and restorative dental procedures x 100)/(Total number of individual preventive, restorative, and surgical dental procedures)	2017	DATASUS

Quantitative variable		mean	SD
Number of dentists per municipality that used SIGAF for antibiotic prescriptions (n=2,294)		7.38	8.95
Categorical variables		N	%
Patients (n=40,630)
	Male	17,081	42.04
	Female	23,549	57.96
Dentists (n=2,294)
	Male	1,074	46.82
	Female	1,220	53.18
Prescribed antibiotics (n=57,279)
	Amoxicillin	48,381	84.47
	Azithromycin	5,091	8.89
	Amoxicillin + Potassium Clavulanate	1,739	3.04
	Cefalexin	1,285	2.24
	Others	783	1.37

Covariates		n (%)		Mean; median
Covariates		G1 counties	G2 counties	G1 counties	G2 counties
Municipality type	Urban	94 (22.33)	107 (24.77)
	Mixed	51 (12.11)	54 (12.50)
	Rural	276 (65.56)	271 (62.73)
Dental Specialties Center (Yes)		36 (8.55)	52 (12.04)
Rural population rate				0.32; 0.30	0.32; 0.29
Gini Index				0.48; 0.48	0.48; 0.48
Human Development Index				0.66; 0.67	0.67; 0.67
Number of families served by the Bolsa Família Program per 1.000 inhabitants				77.80; 69.82	78.18; 71.75
Dentists who work at BNHS per 1.000 inhabitants				0.60; 0.51	0.60; 0.51
Oral Health Teams type I per 1.000 inhabitants				0.19; 0.18	0.22; 0.21
Oral Health Teams type II per 1.000 inhabitants				0.08; 0.00	0.04; 0.00
Percentage of population covered in oral health in the Family Health Strategy				77.00; 99.00	72.00; 93.00
Oral healthcare coverage				87.00; 100	83.00; 100
Coverage of first dental appointment				11.00; 8.00	10.00; 8.00
Percentage of preventive and restorative procedures				90.00; 91.00	89.00; 91.00

Health macro-region	Number of counties	N - % of counties using SIGAF		2016 population
Center	103	41	39.81	820,865
Center South	50	33	66.00	377,858
Jequitinhonha	23	16	69.57	196,162
East	86	49	56.98	702,854
Southeast	53	32	60.38	377,687
Northeast	63	32	50.79	451,539
Northwest	33	23	69.70	466,663
North	86	37	43.02	1,007,808
West	55	39	70.91	789,833
Southeast	94	47	50.00	656,460
South	153	43	28.10	701,738
North Triangle	27	18	66.67	312,623
South Triangle	27	11	40.74	123,233
Total	853	421	49.35	6,985,323

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[1] Collaborations

JS Santos, EA Pereira Júnior and MHNG Abreu conceived the original idea, collected and analyzed data, interpreted the results and wrote the manuscript. EA Pereira Júnior performed statistical analysis by CART. AJS Cruz, EA Pereira Júnior, CM Ruas, FF Mattos and M Klevens interpreted the results and revised the manuscript. All authors reviewed and approved the final draft.