Effect of Quality of Dental Health Services to Patient Satisfaction in Indonesia 2019: Importance-Performance Analysis

ABSTRACT Objective: To determine the effect of the quality of dental health services based on dimensions of empathy and responsiveness to patient satisfaction in urban and rural areas in Bone District, Indonesia. Material and Methods: This survey used an analytical observational method with a pilot pathfinder survey design. The total of participants included in this survey was 442, with 223 in the urban area and 219 in the rural area. This survey was held on 25 February - 1 March 2019. The Mann-Whitney test was applied, adopting a significance level of 5%. Results: Empathy and responsive dimensions in urban (3.58 ± 0.94 and 3.50 ± 0.94) and rural (3.43 ± 0.99 and 3.63 ± 0.86) areas were in the moderate category. The administration staff was able to complete administrative procedures, and the Dental assistant responded promptly to the patient's request and needs. Conclusion: The quality of empathy and responsiveness dimensions in dental treatment fall in the moderate category for urban and rural areas; this means that empathy and responsiveness dimensions in dental service in hospital/public health need to be improved.

The importance of compassionate care / A importância do cuidado humanizado na Odontologia

Recently, studies have highlighted the importance of compassionate care in healthcare. Not only does it improve patient outcomes and satisfaction, but it also improves the healthcare providers' overall well-being. Furthermore, it helps streamline the healthcare system by shortening hospital stays and rates or readmittance. Unfortunately, patients report that they feel there is a lack of compassionate care provided to them, thus shedding light on the compassion crisis. The compassion crisis seems to have its roots in healthcare professional education, as evidenced by the high levels of burnout experienced by students, particularly in dental students. Compassion training, however, not only equips healthcare professionals with strategies to more effectively treat their patients, but also with coping mechanisms to better handle the stressors of their profession. Dentistry is no exception and has some unique barriers to care as well such as communication, the physical barrier during treatment. This further highlights the importance of compassionate care while providing treatment. Implementing compassionate care to be taught in school will improve patient outcomes and provider well-being (AU)

Recentemente, estudos destacaram a importância da empatia na área da saúde. A empatia não só melhora resultados e satisfação do paciente, mas também melhora o bem-estar dos profissionais de saúde. Além disso, ajuda a diminuir o custo do sistema de saúde ao reduzir as internações hospitalares e as taxas de reinternação. Infelizmente, os pacientes relatam que sentem falta de empatia, levando a uma atual crise de falta de empatia nos servicos de saúde. A crise da falta de empatia parece ter suas raízes na formação dos profissionais de saúde, como evidenciado pelos altos níveis de burnout experimentados pelos alunos, principalmente em estudantes de Odontologia. Treinamento para empatia, no entanto, não apenas prepara os profissionais de saúde com estratégias para tratar de forma mais eficaz seus pacientes, mas também com mecanismos de enfrentamento para lidar melhor com os fatores de estresse da profissão. A Odontologia não é exceção e tem algumas barreiras específicas, como a comunicação, que fica comprometida durante o tratamento odontológico. Isso destaca ainda mais a importância da empatia durante o tratamento. Ensinando empatia nos cursos de Odontologia melhorará os resultados para os pacientes e o bem-estar dos profissionais. (AU)

Empathy in Professors and Students of a School of Dentistry in the Caribbean

Abstract Objective: To estimate and compare the levels of empathy between undergraduate dentistry students and professors at a university in the Dominican Republic. Material and Methods: Cross-sectional and descriptive study. The studied population consisted of two groups. The first: students of the Dentistry Career (N=520; n=335: 64.42% of total students) were distributed in two areas, basic-preclinical and clinical, while the second group corresponded of teachers who work in both areas (N=92; n=56; 60.87% of all teachers). The total sample was n = 391. The Jefferson Scale of Physician Empathy (S-Version) was used. Reliability was estimated using Cronbach's α and intraclass correlation coefficient, descriptive statistics, two-way analysis of variance, Tukey's test, effect size, and power of the test. Significance level: α≤0.05 and β≤0.20. Results: The empathy and dimension values were, in general, higher in the professors of the clinical area in relation to the other areas studied, with the exception of the compassionate care dimension. Conclusion: The finding that clinical teachers have a greater value of empathy is potentially an advantage for training students, especially in the clinical area (AU).

Percepção do paciente frente a ortodontistas com diferentes estereótipos: desenvolvimento, propriedades psicométricas e aplicação de um instrumento de avaliação / Patient's perception of orthodontists with different stereotypes: development, psychometric properties and application of an evaluation instrument

Esta pesquisa objetivou desenvolver e validar um questionário que considere julgamentos sociais e, através de sua aplicação, avaliar se a presença de piercings, tatuagens, barba e cabelo solto visíveis na região de face e pescoço refletem na percepção do paciente frente a características do escopo profissional do Ortodontista. Para isso, o questionário desenvolvido teve suas propriedades psicométricas avaliadas e foi aplicado em 220 jovens e adultos, com idade entre 18 e 70 anos, que responderam sobre sua percepção frente a 12 imagens manipuladas de Ortodontistas com diferentes estereótipos, levando em considerações os seguintes itens: higiene, cuidado, pontualidade, experiência e conhecimento em Ortodontia. Como resultado, o questionário desenvolvido apresentou alta aceitabilidade, confiabilidade e validade do constructo confirmadas e consistência interna satisfatória. O estereótipo interferiu na percepção de profissionalismo (p<0.01), onde o Ortodontista com características combinadas (barba/cabelo solto, piercing, brinco e tatuagem) obteve os menores escores médios, tanto para cada item do questionário individualmente (p<0.01) quanto no total (p<0.01). Ser ou não profissional da área da saúde (p=0.427) e nível educacional (p=0.285) não influenciaram na percepção, porém, houve diferença significativa para as faixas etárias (p=0.041). Assim, concluiu-se que o questionário desenvolvido se provou válido e confiável para aplicação. Ortodontistas com piercings e tatuagens na região da face e pescoço foram considerados menos profissionais. Ser ou não profissional da saúde e nível educacional não influenciaram na percepção, porém, indivíduos mais velhos (51 a 70 anos) foram mais críticos no julgamento dos estereótipos do que indivíduos jovens (18 a 30 anos). (AU)

This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, to assess whether the presence of piercings, tattoos, beard and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope. For this, the questionnaire developed had its psychometric properties evaluated and was applied to 220 young people and adults, aged between 18 and 70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, taking into account the following items: hygiene, care, punctuality, experience and knowledge in Orthodontics. As results, the questionnaire developed showed high acceptability, confirmed reliability and validity of the construct and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (p<0.01), where the orthodontist with combined characteristics (beard/loose hair, piercing, earrings and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (p<0.01) and in total (p<0.01). Being a health professional (p=0.427) and educational level (p=0.285) did not influence the perception, however, there was a significant difference for the age groups (p=0.041). Thus, it was concluded that the developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level did not influence the perception, however, older individuals (51 to 70 years) were more critical in judging stereotypes than younger individuals (18 to 30 years). (AU)

Alteridade e empatia: virtudes essenciais para a formação do cirurgião-dentista / Alterity and empathy: essential virtues for the formation of the dentist

O atendimento profissional vinculado à saúde se deve a certas premissas que ultrapassam o aspecto meramente técnico. Para que transformações ocorram, a atenção às mudanças curriculares é indispensável durante a formação do cirurgião-dentista. O ensino superior carece de estratégias que remodelem a forma de se pensar o outro. Empatia e alteridade são virtudes que, se desencadeadas, podem alterar a relação profissional-paciente. Buscou-se elucidar o significado desses conceitos, como proposta reflexiva em consonância com o atendimento humanizado em saúde, as Diretrizes Curriculares Nacionais (DCN), e o contato com o Sistema Único de Saúde (SUS), como propulsores de transformações no meio acadêmico. Adotou-se a revisão narrativa da literatura, pela pesquisa documental, contemplando a legislação nacional acerca da educação superior em Odontologia, somada a consulta às bases científicas Medline, LILACS e SciELO. As palavras-chave empregadas foram: alteridade, empatia, empathy, humanização da assistência e humanization of assistance, no período de 2004 a 2017. Foram selecionados textos completos na área odontológica que contemplassem a interrelação entre os temas. A síntese qualitativa da literatura consultada permitiu a observação de que houve uma mudança, ainda não totalmente concretizada, mas relevante, com relação à ultrapassagem do foco apenas técnico e curativo, como bem proposto nas DCN e tão almejado pelo SUS quanto ao profissional ingressante na vida pública. Concluiu-se que o atendimento humanizado em Odontologia ainda é um desafio. Contudo, mudanças acadêmicas que suscitem o despertar das virtudes de alteridade e empatia devem se concretizar (AU).

Professional care related to health must be based on certain assumptions that go beyond the technical aspect. For transformations to take place, attention to curricular changes is indispensable during the formation of the dental surgeon. The higher education lacks strategies that reshape the way one thinks about the other. Empathy and alterity are virtues that are unleashed, can alter the professional-patient relationship. The aim was to discuss the proposals of the National Curricular Guidelines (NCG), and the contact with the Unified Health System (UHS), as drivers of changes in the academic environment. It was adopted the narrative review of the literature, through documentary research, contemplating the national legislation on higher education in Dentistry, in addition to consulting the scientific bases Medline, LILACS, and SciELO. The keywords used were: alteridade, empatia, empathy, humanização da assistência e humanization of assistance, from 2004 to 2017. Full texts were selected in the dental area that contemplated the interrelationship between the themes. The qualitative synthesis of the literature consulted allowed the observation that there was a change, not yet fully realized, but relevant, in relation to the surpassing of the only technical and curative focus, as well proposed in the NCG and so longed for by the UHS as the professional in public life. Humanized care in Dentistry is still a challenge. However, academic changes that arouse the awakening of the virtues of alterity and empathy must materialize (AU).

Levels of Empathy Orientation after the Implementation of a New Curriculum

Objective: To compare the level of empathy orientation of the students in the Dentistry Program from the Universidad Metropolitana according to gender and levels of education after the implementation of a new curriculum. Material and Methods: An exploratory and transversal research was made. The studied population are the students from the first and the fifth academic year in the Dentistry Undergraduate Program from the Universidad Metropolitana (Barranquilla, Colombia) (n = 371, N = 482; 76.97% of the population) First: 92; Second: 83; Third: 60; Fourth: 71 and Fifth: 65, being females = 235 and males = 136. Data collection was done in March 2016 for the present study and in 2012. The Jefferson Scale of Physician Empathy was applied to participants. Results: For the "Academic Years" factor, the means in the first undergraduate years are similar with an increase in the last two undergraduate years; females have superior values than males. However, the behavior of these means is different when analyzing the combined levels of both factors. The female gender increases steadily in the first four years and decreases in the fifth year; The male gender goes down from first to second place and increases steadily until the fifth year surpassing the female in this last year. Conclusion: The general results obtained on empathy have improved compared to those results from 2012. The questions that obtained significant scores were those related to the cognitive component. This could be explained by the incorporation of a greater number of community activities into vulnerable population.

Changes in Empathy Levels on Dentistry's Students of Public University in Cartagena City, Colombia

Objective: To compare levels of empathy in dentistry students in the cohorts of 2013 and 2016 years, in a public university in Cartagena, Colombia. Material and Methods: The sample consists of 332 students from first to fifth academic year. The instrument used was the Jefferson Medical Empathy Scale (EEMJ), Spanish version for medical students (version S), validated in Mexico and Chile and adapted for students of dentistry in Colombia. Implementation was anonymous and confidential and informed consent was used. The scale was judged by judges in order to verify cultural validity and students' understanding of the scale was evaluated. The means and standard deviation were estimated. A bifactorial variance analysis, model III was applied to find differences of means between academic years, the genders and in the interaction of these factors. The comparison between empathic cohort data 2013 and 2016 was performed using the Wilks Lambda Statistician and the M Box test. The level of significance used was α≤0.05 and ß<0.20. Results: The results were significant for the "academic years" factor (p = 0.027), gender (p = 0.782) and interaction (p = 0.364) were not significant. The size of the effect of the statistical differences found is not high. The value of R2 corrected shows that the factors studied explain only 2.9% of all the variation of empathy. Conclusion: The empathy in the study subjects presents some fluctuations; however there are no statistically significant differences for the factors of interest among the cohorts evaluated.

O uso de protocolos na gestão do cuidado da hipertensão arterial na atenção primária à saúde: uma revisão integrativa / The use of protocols in the care management of hypertension in primary health care: an integrative review

Introdução: O uso de protocolos, na assistência a hipertensão arterial sistêmica (HAS), permite um melhor direcionamento nas condutas profissionais. Objetivos: Identificar na literatura nacional e internacional, a existência de protocolos para otimizar a gestão do cuidar ao cliente com HAS assistido na Atenção Primária à Saúde. Metodologia: Trata-se de uma revisão integrativa (dezembro/2016 a janeiro/2017) cuja busca foi realizada nas Bases: Scopus, Lilacs, Medline, Scielo, PubMed e Biblioteca Cochrane. A análise da pertinência dos estudos deu-se com a escala de Likert e índice de concordância, a textual com agregação dos objetivos e resultados em categorias. Likert > 4 classificou os estudos em muito pertinente. O índice de concordância foi > 88%. Resultados: Foram incluídos 10 estudos e todos mostraram a importância do uso de protocolos como estratégia para o acompanhamento e controle da HAS. As categorias encontradas foram: avaliação, adesão e satisfação. Conclusão: Apesar da baixa adesão aos protocolos, a sua utilização é uma ferramenta importante no controle da HAS, e para um cuidar integral, é necessário um protocolo voltado para a equipe multiprofissional, que conte com a adesão de gestores, profissionais e clientes, reforçando a integralidade do cuidar (AU).

Introduction: The use of protocols, in the assistance to systemic arterial hypertension (SAH), allows a better orientation in the professional conducts. Aims: The objective of this study was to identify, in the national and international literature, the existence of protocols to optimize the management of care for clients with systemic arterial hypertension assisted in Primary Health Care. Methods: It consists of an integrative review from December/2016 to January/2017. Bases: Scopus, Lilacs, Medline, Scielo, PubMed and Cochrane Library. The pertinence analysis of the studies was in pairs using Likert scale and concordance index, and the textual one with aggregation of the objectives and results in categories. The Likert scale > 4 classified the studies as very relevant. The concordance index was > 88%. Results: 10 studies were included in the research and they all showed the importance of the use of protocols as a strategy for the follow-up and control of SAH, although targeted at specific professionals. The categories found were: evaluation, adherence and satisfaction. Conclusions: Despite the low adherence to the protocols, its use is an important tool for the control of SAH, and for a full care, a protocol is needed for the multiprofessional team, that has the adhesion of managers, professionals and clients, Reinforcing the integrality of caring (AU).

Empathy, Components of Empathy and Curricular Evaluation of the Faculty of Dentistry, Evangelical University of El Salvador

Objective: To estimate empathy levels in general and empathic growth potential in dental students. Material and Methods: This is an exploratory, transversal study. The study population is made up of students from the first to fifth academic year of the career of dentistry of the Evangelical University of El Salvador (El Salvador) (148/240, 61.67% of the population studied). The participants were given the Jefferson Empathy Medical Scale, the Spanish version for medical students, validated in Chile and Mexico, and culturally adapted in El Salvador. A bifactorial variance analysis (model III) was applied to find differences in the means between the courses, between the genders and in the interaction between these two factors. The data were described using simple arithmetic graphs, processed with SPSS 22.0. Total growth potential was estimated. Results: Differences were found between academic years, but not in gender of empathy in general and in its components. The levels of empathy and its components are low in relation to other studies. The behavior of the levels of empathy agrees with the concept of empathic decline. The masculine gender presented levels of empathy, in absolute values, greater than the feminine. There is considerable potential for growth in empathy and that of its components. Conclusion: The behavior of the levels of empathy observed in this work does not agree with the concept of empathic decline. The differences observed between the genders were not consistent with those reported by other authors and it is possible that these findings constitute further evidence that empathy itself is not a female attribute.

Percepções de gestantes sobre a promoção do parto normal no pré-natal / Perception of pregnant women about the promotion of normal birth in the prenatal

Introdução: O parto normal deve ser estimulado na assistência pré-natal. Objetivo: Conhecer a percepção de gestantes, de uma equipe da Estratégia de Saúde da Família de Parnamirim/RN, sobre a promoção do parto normal no pré-natal. Métodos: Trata-se de um estudo exploratório, descritivo e de abordagem qualitativa. Foram realizadas entrevistas com 17 gestantes e analisadas pela análise de conteúdo. Resultados: As gestantes relataram que existem poucas atividades educativas de promoção ao parto no pré-natal; apontaram a necessidade de melhor comunicação por parte dos profissionais; demonstraram entender a importância da preparação na gravidez para o parto, mesmo as orientações e informações sendo falhas; e contribuíram com opiniões de métodos educativos para promoção do parto normal no pré-natal. Conclusões: Recomenda-se a realização de ações educativas em grupo e estratégias para o fortalecimento de vínculo entre a equipe e as gestantes, buscando uma melhor promoção ao parto normal e assistência pré-natal de qualidade (AU).

Introduction: Normal birth should be stimulated in prenatal care. Objective: To know the perception of pregnant women, from a team of the Family Health Strategy of Parnamirim/RN, on the promotion of normal prenatal delivery. Methods: This is an exploratory, descriptive and qualitative approach. Interviews were conducted with 17 pregnant women and analyzed by content analysis. Results: Pregnant women reported that there are few educational activities to promote prenatal delivery; pointed out the need for better communication by professionals; have demonstrated the importance of preparing pregnancy for childbirth, even when guidelines and information are flawed; and contributed with opinions of educational methods to promote normal prenatal delivery. Conclusions: It is recommended to carry out group educational actions and strategies to strengthen the bond between the team and the pregnant women, seeking a better promotion of normal delivery and quality prenatal care (AU).