Protocolo de Avaliação da Saúde Bucal na Atenção Básica

MOIMAZ, Suzely Adas Saliba; MELO, Lúcia Maria Lima Lemos de; GARBIN, Cléa Adas Saliba; GARBIN, Artênio José Ísper; SALIBA, Nemre Adas

doi:10.1590/1981-863720150003000113012

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Original • Rev Gaúch. Odontol. 63 (4) • Oct-Dec 2015 • https://doi.org/10.1590/1981-863720150003000113012 copiar

Protocolo de Avaliação da Saúde Bucal na Atenção Básica

Sobre os autores

Objetivo:

Analisar o funcionamento do serviço de Saúde Bucal em um município e desenvolver um protocolo de avaliação diagnóstica da Saúde Bucal na Atenção Básica.

Métodos:

Trata-se de uma pesquisa quanti-qualitativa, descritiva. O local da pesquisa foi Pereira Barreto, São Paulo, por apresentar a Estratégia Saúde da Família como modelo assistencial estruturante do Sistema de Atenção à Saúde em 100% da população; equipes de saúde bucal implantadas; atenção secundária em saúde bucal. Os dados foram obtidos por meio de entrevistas com o gestor, 6 cirurgiões-dentistas, 6 auxiliares de saúde bucal e 6 agentes comunitários de saúde. Foram realizadas também análise documental do Plano Municipal de Saúde, Agenda de Saúde Bucal e observação in loco da estrutura odontológica.

Resultados:

O município oferta serviços de saúde bucal com integração entre atenção básica e especializada, sendo a atenção básica ordenadora da rede. O Plano Municipal de Saúde apresenta descrição detalhada da situação geral do município; a agenda de saúde bucal preconizada em fase de implantação contempla os três eixos de atuação da Estratégia Saúde da Família: unidade de saúde, família e comunidade. O inquérito identificou que a principal forma de acesso da população aos serviços era a demanda espontânea; havia duas equipes de Saúde da Família sem equipes de Saúde bucal.

Conclusão:

A análise do funcionamento do serviço possibilitou desenvolver um protocolo com dimensões específicas de Saúde Bucal para subsidiar o gestor na definição de estratégias de intervenção.

Saúde bucal; Atenção primária à saúde; Avaliação em saúde; Gestão em saúde

Amplitude	Municipal Health Plan (MHP) items to be analyzed	Suggestions for oral health area assessment	Referencies
Situacional analises	Health System Structure	Health surveillance, Primary Care, Specialized Outpatient Care, Hospital Care, Emergency Assistance and Urgent needs, Pharmaceutical Services, Municipal Health Secretariat	Fluoridation of public water supplies; Fluorine external control; Strategy adopted in primary care: -Health Family: Implementation of the Oral Health Teams Family Health, Oral Health actions in CSFH (Centers of Support for Family Health); -Traditional-model: Identification of the establishment which develop oral health actions: Basic health Units, isolated offices, dental centers, mobile units; Oral health actions developed in the Health School Programme (HSP) OEC; RLDP; Dentistry in the hospital service; hire an oral health coordinator	Ordinance n⁰ 2.135, Pact system: SISPACTO Policy Guideline for National Oral Health, DEC 6.286/2007: health program at school Technical invoice Nº 01/2014 MS, Decree 124- Federal Council of Dentistry, Ordinance 2488: AB National Policy.
	Health care networks	Stork network, Psychosocial Care Network (PSCN),Urgent needs and Emergency network, Care Network for Chronic Diseases, Care Network for People with Disabilities	Oral Health Inclusion in networks.	Ordinance nº1459 Ordinance nº 3.088 Ordinance nº 1.600 Ordinance nº 483 Ordinance 793
	sociosanitary status	Socio-demographic and Epidemiological Profile	Oral health rates by age group or specific group tooth decay: OEC, DMF 12 % of children aged 5-5 and others.	Guidelines for Primary Care in Oral Health of the Municipal Health Department of São Paulo-2009
	Access Flow	Health Basic Unit, Hospital, AME, Family Health support Centre , OEC	Risk screening flows screening (Example: decay, oral lesions), and RLDP, Reference Guide and counter references.
	Financial AIDS	Federal, State and Municipal financial resources	Financial resource for oral health received from three levels of government, including special programs.		OHT resource, OEC, RLDP, São Paulo Smile Programme
Amplitudes	Items to be analized	Suggestions for Oral Health evaluation.	Reference		OHT resource, OEC, RLDP, São Paulo Smile Programme
Situacional Analysis	Management of Work and Education in Health	Training and capacity building	Continuing Education and Continuing Oral Health Actions, integration of oral health with the work process; Primary Care, Health Network and Management;, integration of oral health with the work process; Primary Care, Health Network and Management;	Ordinance n⁰ 2.135, SISPACTO, Policy Guideline for National Oral Health (PGNOH).
Situacional Analysis	Science, technology, production and innovation in health and management.	Epidemiological research in oral health	Municipal participation in university and government research (Example: survey of oral health conditions in schools and in households).
Goals, guidelines, indicators targets	Guidelines and targets to be achieved which will contribute to reach goals	Sispacto: agreed indicators in three levels : governmental and others/ Municipal Health Report of government conference	Examples of oral health indicators: population coverage of oral health services in primary care, an average of supervised tooth brushing, first programmatic dental appointment coverage, treatment rate completed in relation to the initiated, etc.		BRAZIL. Ministry of Health Reports: Goals and Indicators for composition of Part II of Organizational Contract of Public Action. Brasília, 2012
Assessment and. Monitoring	Follow-up tools and evaluation	User satisfaction form. Coverage and productivity parameters National Improvement Program Access and Health Care Quality. Indicators and targets set out in Municipal Health Plan	Oral health inserted in assessment processes. Manager, employee and user evaluation participation in the process of the health service.	Policy Guideline for National Oral Health, (PGNOH), Ordinance nº 1.654: monitoring and evaluation program of primary care quality, program monitoring and quality assessment OEC, Health Municipal Plan

Tool	Amplitude	Analyzed items in the questionnaire and Oral health Agenda	Reference
Questionnaire	Infrastructure	Facility resources: number of units providing dental service: BHU, OEC, RLPD, isolated offices, mobile units, Dental Center Human-resource dentists, (DDS), oral health assistants (OHA), Health Community Assistants (OCA)	Ordinance nº 2.488: AB National Policy, Policy Guideline for National Oral Health (PGNOH), Policy of Humanization and Continuing Education.
	Acess and regulation	Spontaneous demand, priority groups, risk screening, referral and counter-referral Guide
	Work organization procedures	Care model adopted, Planning, Intersectoriality: Ex: Health School Programme (HSP),Teamwork: multidisciplinary, interdisciplinary, Care Networks in Health, Humanization Technical Group, risk classification, welcoming
	Assessment strategies	User satisfaction form, coverage parameters and productivity, (PPC)
Oral health agenda	Priority groups	School children, pregnant women, patients with hypertension, diabetic patients, the elderly, babies, participants who receive governmental financial help, others.		Report primary care information system (PCIS) Ordinance nº 2. 488: AB National Policy, Policy Guideline for National Oral Health, Agenda recommended in the city.
	Urgent needs and free demand	Daily periodicity
	Team meetings	Frequency: Weekly or another, integration with the Family Health Team
	Home visits	Scheduled according to the needs
	Administrative activities	Daily computorized fulfillment
	Risk Evaluation	School, priority groups of Basic Health units and others, campaigns

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[1] Collaborators SAS Moimaz and LMLL MELO participated in the conception, design, analysis and interpretation of data and writing of the article. CAS GARBIN, AJI GARBIN and NA SALIBA participated in the analysis and interpretation of data and writing of the article.