Oral healthcare management practices in Brazil: systematic review and metasummary

Corresponding author: Mitsue Fujimaki Department of Dentistry, State University of Maringá. Av. Mandacaru 1.550, 87080000 – Maringá, PR, Brazil. Phone: (44) 991116464. E-mail: mfujimaki@uem.br

Editor: Altair A. Del Bel Cury

Author Contribution

Tânia Harumi Uchida: Data curation, investigation, methodology, project administration, validation, original draft, writing, review and editing.

Uhana Seifert Guimarães Suga: Data curation, Investigation, Methodology.

Clarissa Garcia Rodrigues: Methodology.

Josely Emiko Umeda: Writing, review and editing.

Mark Tambe Keboa: Review and editing.

Raquel Sano Suga Terada: Writing, review and editing.

Mitsue Fujimaki: Conceptualization, data curation, investigation, methodology, project administration, validation, original draft, writing, review and editing.

All authors actively participated in the discussion of the manuscript’s findings, and have revised and approved the final version of the manuscript.

Study	Number of Participants		Setting	Context of the Study

	Dentists	Managers
Aguilera et al.¹⁸ (2013)	0	17	Paraná	Municipal Health Office
Aquilante and Aciole¹⁹ (2015)	38	11	São Paulo	Regional Department of Health of São Paulo
Araújo and Dimenstein²⁰ (2006)	21	0	Rio Grande do Norte	Dentists from the Family Health Strategy (FHS)
Cavalcanti et al.²¹ (2012)	17	0	Paraíba	Basic Health Unit (BHU)
Chaves and da Silva²² (2007)	9	0	Bahia	Dentists in the primary healthcare systems
Correa et al.²³ (2010)	6	2	Amazonas	Dentists inserted in the FHS, Municipal Health Department and Oral Health Coordinator at FHS
Fernandes et al.²⁴ (2015)	11	0	Santa Catarina	Dentists inserted in the FHS
Lippert et al.²⁵ (2020)	14	0	Paraná	Dentists from the Basic Health Units (BHU) and Dental Specialties Centers
Mello et al.²⁶ (2014)	0	10	Santa Catarina	SUS managers
Moimaz et al.²⁷ (2008)	0	3	São Paulo	Regional Department of Health
Nascimento et al.²⁸ (2009)	58	0	São Paulo and Paraná	Dentists worked in the ESF
Padilha et al.²⁹ (2005)	74*		Paraíba	Dentists worked in the FHS and as managers
Pimentel et l.³⁰ (2010)	3	12	Pernam-buco	FHS Health District VI
Rodrigues et al.³¹ (2011)	31*		Bahia	FHS
Rossi and Chaves³² (2015)	8	5	Bahia	Oral Health Management Team
Sá et al.³³ (2015)	23	1	Santa Catarina	FHS
Santos et al.³⁴ (2007)	4	0	Bahia	FHS
Santos and Assis³⁵ (2006)	11*		Bahia	FHS
Silva Junior et al.³⁶ (2020)	0	9	Ceará	State Health Managers
Vieira et al.³⁷ (2013)	8	0	São Paulo	Public Sector
Baldani et al.³⁸ (2005)	105	0	Paraná	Oral health team (OHT) at the FHS
Colussi and Calvo³⁹ (2011)	0	207	Santa Catarina	Municipal Health Managers
Godoi et al.⁴⁰ (2013)	0	1	Santa Catarina	Municipal Health Managers
Godoi et al.⁴¹ (2014)	0	12	Santa Catarina	Municipal Health Managers
Lessa and Vettore⁴² (2010)	0	3	Ceará	Municipal Health Office
Lourenço et al.⁴³ (2009)	278**	166	Minas Gerais	OHT at the FHS
Mattos et al.⁵ (2014)	43	14	Minas Gerais	OHT at the FHS
Souza and Roncalli⁴⁴ (2007)	25	19	Rio Grande do Norte	OHT at the FHS
Aquilante and Aciole⁴⁵ (2015)	38	11	São Paulo	Regional Department of Health of São Paulo
Moretti et al.⁴⁶ (2010)	67	9	Paraná	OHT
TOTAL	498	512

Qualitative studies according CASP (N=20)
Included articles	Quality variables assessment*										Risk of bias assessment
Included articles	Clarity of purpose	Qualitative methodology appropriateness	Justification for the qualitative methodology	Participant recruitment strategy	Data collection	Relationship between researcher and participants	Ethical issues	Data analysis	Clarity of results	Study relevance	Risk of bias assessment
Aguilera et al.¹⁸ (2013)											High
Aquilante and Aciole¹⁹ (2015)											High
Araújo and Dimenstein²⁰ (2006)											High
Cavalcanti et al.²¹ (2012)											High
Chaves and da Silva²² (2007)											High
Correa et al.²³ (2010)											High
Fernandes et al.²⁴ (2015)											High
Lippert et al. ²⁵ (2020)											High
Mello et al.²⁶ (2014)											High
Moimaz et al.²⁷ (2008)											High
Nascimento et al.²⁸ (2009)											High
Padilha et al.²⁹ (2005)											High
Pimentel et al.³⁰ (2010)											High
Rodrigues et al.³¹ (2011)											High
Rossi and Chaves³² (2015)											High
Sá et al.³³ (2015)											High
Santos et al.³⁴ (2007)											High
Santos and Assis³⁵ (2006)											High
Silva et al.³⁶ (2020)											High
Vieira et al.³⁷ (2013)											High
Surveys according Bennett (N=8)
Quality variables assessment*	Included article
	Lourenço et al.⁴³ (2009)	Baldani et al.³⁸ (2005)	Mattos et al.⁵ (2014)		Godoi et al.⁴¹ (2014)	Souza and Roncalli⁴⁴ (2007)	Lessa and Vettore⁴² (2010)		Colussi and Calvo³⁹ (2011)	Godoi et al.⁴⁰ (2013)
Justification of the research question
Explicit research question
Clarity of purpose
Description of methods used for data analysis
Method of administering the questionnaire
Location and date
Methods sufficiently described for replication
Evidence of reliability
Evidence of validity
Use of encoding
Sample size calculation
Representativeness of the sample
Sample selection method
Description of the sample population
Description of the search tool
Description of tool development
Pre-test instrument
Reliability and validity instrument
Consent
Ethical approval
Evidence of ethical treatment of research participants
Risk of bias assessment	Low	Low	Moderate		Moderate	Moderate	Moderate		High	High
Mixed-model studies according O’Cathain (N=2)
Included articles	Quality variables assessment*									Risk of bias assessment
Included articles	Assessment of study success	Assessment of study design		Assessment of the quantitative component	Assessment of the qualitative component		Assessment of study integration	Assessment of study inferences		Risk of bias assessment
Aquilante and Aciole⁴⁵ (2015)										High
Moretti et al.⁴⁶ (2010)										High

STRUCTURAL MANAGEMENT		CARE MANAGEMENT		MANAGEMENT OF THE WORK

Codes/ References	Effect size frequency (%)	Codes/ References	Effect size frequency (%)	Codes/ References	Effect size frequency (%)
Healthcare networks Aguilera et al.¹⁸ (2013), Aquilante and Aciole⁴⁵ (2015), Cavalcanti et al.²¹ (2012), Chaves and da Silva²² (2007), Colussi and Calvo³⁹ (2011), Fernandes et al.²⁴(2015), Lippert et al.²⁵ (2020), Godoi et al.^40,41 (2013, 2014), Lessa and Vettore⁴² (2010), Lourenço et al.⁴³ (2009), Mattos et al.⁵ (2014), Mello et al.²⁶ (2014), Padilha et al.²⁹ (2005), Pimentel et al.³⁰ (2010), Rossi and Chaves³² (2015), Silva et al.³⁶ (2020), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	63,3	User satisfaction Cavalcanti et al.²¹ (2012)	3,3	Autonomy of management Vieira et al.³⁷ (2013)	3,3
Care Diagnosis and Planning Aguilera et al.¹⁸ (2013), Aquilante and Aciole^19,45 (2015), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Correa et al.²³ (2010), Fernandes et al.²⁴ (2015), Godoi et al.^40,41 (2013, 2014), Lessa and Vettore⁴² (2010), Lourenço et al.⁴³ (2009), Mattos et al.⁵ (2014), Mello et al.²⁶ (2014), Moimaz et al.²⁷ (2008), Moretti et al.⁴⁶ (2010), Nascimento et al.²⁸ (2009), Padilha et al.²⁹ (2005), Rossi and Chaves³² (2015), Sá et al.³³ (2015), Santos et al.³⁴ (2007), Santos and Assis³⁵ (2006), Silva Junior et al.³⁶ (2020), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	80	Expanded Clinical Service Aquilante and Aciole^19,45 (2015), Baldani et al. (2005)³⁸, Chaves and da Silva²² (2007), Colussi and Calvo³⁹ (2011), Correa et al. ²³ (2010), Fernandes et al.²⁴ (2015), Godoi et al.⁴¹ (2014), Mattos et al.^5,26 (2014), Moretti et al.⁴⁶ (2010), Nascimento et al.²⁸ (2009), Pimentel et al.³⁰ (2010), Santos et al.³⁴ (2007), Santos and Assis³⁵ (2006), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	56,7	Individual performance Chaves and da Silva²² (2007)	3,3
Budget and Funding Lourenço et al.⁴³ (2009), Moimaz et al.²⁷ (2008), Rossi and Chaves³² (2015), Vieira et al.³⁷ (2013)	13,3	Social Control Aquilante and Aciole⁴⁵ (2015), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Colussi and Calvo³⁹ (2011), Moimaz et al.²⁷ (2008), Nascimento et al.²⁸ (2009), Santos et al.³⁴ (2007)	23,3	Creativity, initiative, motivation and innovation Aquilante and Aciole¹⁹ (2015), Chaves and da Silva²² (2007), Correa et al.²³ (2010)	10
Infrastructure and materials Aguilera et al.¹⁸ (2013), Baldani et al.³⁸ (2005), Correa et al.²³ (2010), Lourenço et al.⁴³ (2009), Mello et al.²⁶ (2014), Souza and Roncalli⁴⁴ (2007), Rossi and Chaves³² (2015), Santos et al.³⁴ (2007), Vieira et al.³⁷ (2013)	30	Ongoing Health Education Aquilante and Aciole^19,45 (2015), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Fernandes et al.²⁴ (2015), Godoi et al.^40,41 (2013, 2014), Lourenço et al.⁴³ (2009), Moretti et al.⁴⁶ (2010), Nascimento et al.²⁸ (2009), Santos and Assis³⁵ (2006), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	43,3	Continuing Education Aguilera et al.¹⁸ (2013), Aquilante and Aciole⁴⁵ (2015), Chaves and da Silva²² (2007), Lourenço et al.⁴³ (2009), Nascimento et al.²⁸ (2009), Rodrigues et al.³¹ (2011), Santos and Assis³⁵ (2006), Vieira et al.³⁷ (2013)	26,7
Information systems and evaluation Aquilante and Aciole⁴⁵ (2015), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Colussi and Calvo³⁹ (2011), Godoi et al^40,41 (2013, 2014), Moimaz et al.²⁷ (2008), Pimentel et al.³⁰ (2010), Souza and Roncalli⁴⁴ (2007)	30	Family Health Strategy Aguilera et al.¹⁸ (2013), Aquilante and Aciole^19,45 (2015), Araújo and Dimenstein²⁰ (2006), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Chaves and da Silva²² (2007), Fernandes et al.²⁴ (2015), Godoi et al^40,41 (2013, 2014), Lessa and Vettore⁴² (2010), Lourenço et al.⁴³ (2009), Mattos et al.⁵ (2014), Moretti et al.⁴⁶ (2010), Nascimento et al.²⁸ (2009), Padilha et al.²⁹ (2005), Pimentel et al.³⁰ (2010), Santos and Assis³⁵ (2006), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	66,7	Auxiliary Team (Oral Health Technician and Oral Health Assistant) Baldani et al.³⁸ (2005), Correa et al.²³ (2010), Fernandes et al.²⁴ (2015),	10
		Intersectoriality Aquilante and Aciole^19,45 (2015), Baldani et al.³⁸ (2005), Chaves and da Silva²² (2007), Colussi and Calvo³⁹ (2011), Godoi et al.⁴¹ (2014), Mattos et al.⁵ (2014), Mello et al.²⁶ (2014), Moretti et al.⁴⁶ (2010), Padilha et al.²⁹ (2005), Pimentel et al.³⁰ (2010), Santos and Assis³⁵ (2006), Souza and Roncalli⁴⁴ (2007), Vieira et al.³⁷ (2013)	46,7	Qualified Manager Aquilante and Aciole⁴⁵ (2015), Fernandes et al.²⁴ (2015), Rossi and Chaves³² (2015)	10
				University-Health Service Integration Godoi et al.^40,41 (2013, 2014), Mello et al.²⁶ (2014)	6,7
				Interpersonal relationship Vieira et al.³⁷ (2013)	3,3
				Interprofessional teamwork Aquilante and Aciole^19,45 (2015), Baldani et al.³⁸ (2005), Cavalcanti et al.²¹ (2012), Chaves and da Silva²² (2007), Colussi and Calvo³⁹ (2011), Fernandes et al.²⁴ (2015), Lourenço et al.⁴³ (2009), Mello et al.²⁶ (2014), Moretti et al.⁴⁶ (2010), Nascimento et al.²⁸ (2009), Padilha et al.²⁹ (2005), Pimentel et al.³⁰ (2010)	40

Article	IES % all codes (n = 20)	IES % codes > 25% (n= 10)
Aguilera et al.¹⁸ (2013)	15	30
Aquilante and Aciole¹⁹ (2015)	35	60
Aquilante and Aciole⁴⁵ (2015)	50	90
Araújo and Dimenstein²⁰ (2006)	10	20
Baldani et al.³⁸ (2005)	45	80
Cavalcanti et al.²¹ (2012)	30	40
Chaves and da Silva²² (2007)	35	50
Colussi and Calvo³⁹ (2011)	15	30
Correa et al.²³ (2010)	25	30
Fernandes et al.²⁴ (2015)	30	50
Godoi et al.⁴⁰ (2013)	30	40
Godoi et al.⁴¹ (2014)	35	60
Lessa and Vettore⁴² (2010)	15	30
Lippert et al.²⁵ (2020)	5	20
Lourenço et al.⁴³ (2009)	40	70
Mattos et al.⁵ (2014)	25	50
Mello et al.²⁶ (2014)	15	20
Moimaz et al.²⁷ (2008)	15	10
Moretti et al⁴⁶. (2010)	25	50
Nascimento et al.²⁸ (2009)	35	60
Padilha et al.²⁹ (2005)	35	70
Pimentel, Moura and Acioli³⁰ (2010)	30	60
Rodrigues et al.³¹ (2011)	5	10
Rossi and Chaves³² (2015)	25	30
Sá et al.³³ (2015)	5	10
Santos et al.³⁴ (2007)	25	30
Santos and Assis³⁵ (2006)	25	40
Silva et al.³⁶ (2020)	10	10
Souza and Roncalli⁴⁴ (2007)	25	50
Vieira et al.³⁷ (2013)	55	80

[1] Corresponding author: Mitsue Fujimaki Department of Dentistry, State University of Maringá. Av. Mandacaru 1.550, 87080000 – Maringá, PR, Brazil. Phone: (44) 991116464. E-mail: mfujimaki@uem.br

Brasil

Brasil

Oral healthcare management practices in Brazil: systematic review and metasummary

Aim

Methods

Results

Conclusion