What might COVID-19 have taught us about the delivery of Nurse Education, in a post-COVID-19 world?

For Nurse Education in the UK, pre-existing challenges already included the need to develop curricula to align with new Nursing and Midwifery Council (NMC) educational standards; and increased numbers entering pre-registration Nurse Education programmes in order to address workforce deficits. Further disruption due to COVID-19, forced Nurse Educators overnight to rapidly adopt and to innovatively use current and emerging technologies to maintain engagement with, and to continue delivering education to, students during the pandemic. Although the full extent of these enforced changes is unknown at this time, this paper argues that online delivery is a necessary and inevitable transition, addressing some of these pre-existing challenges, and that the pandemic has hastened this. It is therefore crucial that Nurse Educators lead the way in navigating this period of uncertainty, viewing the pandemic as an opportunity to plan for the future, to establish how online teaching and learning can continue to benefit Nurse Education in a post-COVID-19 world, not just in the UK, but across the globe.

Achieving Universal Health Coverage (UHC): Dominance analysis across 183 countries highlights importance of strengthening health workforce.

BACKGROUND: Despite increasing political will to achieve Universal Health Coverage (UHC), there is a paucity of empiric data describing what health system indicators are useful surrogates of country-level progress towards UHC. We sought to determine what public health interventions were useful tracers of country-level UHC progress. METHODS: Across 183 countries we evaluated the extent to which 16 service delivery indicators explained variability in the UHC Service Coverage Index, (UHC SCI) a WHO-validated indicator of country-level health coverage. Dominance analyses, stratifying countries by World Bank income criteria, were used to determine which indicators were most important in in predicting UHC SCI scores. FINDINGS: Health workforce density ranked first overall, provision of basic sanitation and access to clean water ranked second, and provision of basic antenatal services ranked third. In analysis stratified by World Bank income criteria, health workforce density ranked first in Lower Middle Income-Countries (LMICs) (n = 45) and third in Upper Middle Income-Countries (UMICs) (n = 51). CONCLUSIONS: While each country will have a different approach to achieving UHC, strengthening the health workforce will need to be a key priority if they are to be successful in achieving UHC.

Staffing needs for unscheduled activity in obstetrics and gynecology.

INTRODUCTION: To determine a minimum threshold of medical staffing needs (obstetricians-gynecologists, anesthesiologists-resuscitation specialists, nurse-anesthetists, pediatricians, and midwives) to ensure the safety and quality of care for unscheduled obstetrics-gynecology activity. MATERIALS AND METHODS: Face to face meetings of French healthcare professionals involved in perinatal care in different types of practices (academic hospital, community hospital or private practice) who belong to French perinatal societies: French National College of Gynecologists-Obstetricians (CNGOF), the French Society of Anesthesia and Resuscitation Specialists (SFAR), the French Society of Neonatology (SFN), the French Society of Perinatal Medicine (SFMP), the National College of French Midwives (CNSF), and the French Federation of Perinatal Care Networks (FFRSP). RESULTS: Different minimum thresholds for each category of care provider were proposed according to the number of births/year in the facility. These minimum thresholds can be modulated upwards as a function of the level of care (Level 1, 2 or 3 for perinatal centers), existence of an emergency department, and responsibilities as a referral center for maternal-fetal and/or surgical care. For example, an obstetrics-gynecology department handling 3000-4500 births per year without serving as a referral center must have an obstetrician-gynecologist, an anesthesiologist-resuscitation specialist, a nurse-anesthetist, and a pediatrician onsite specifically to provide care for unscheduled obstetrics-gynecology needs and a second obstetrician-gynecologist available within a time compatible with security requirements 24/7; the number of midwives always present (24/7) onsite and dedicated to unscheduled care is 5.1 for 3000 births and 7.2 for 4500 births. A maternity unit's occupancy rate must not exceed 85 %. CONCLUSION: The minimum thresholds proposed here are intended to improve the safety and quality of care of women who require unscheduled care in obstetrics-gynecology or during the perinatal period.

Management crisis of health personnel in the great Maghreb. Mauritania case study.

OBJECTIVE: To describe the number and distribution of health personnel in Mauritania during 2017, according to their academic grades and administrative assignments. METHODS: This is a quantitative study of the number and uses of health human resources in Mauritania, based on the 2017 data from the Personnel Register of the Ministry of Health. The number of doctors, midwives and nurses in the six administrative regions of Mauritania and its "wilayas", were standardized according to the size of the population (health workers /10 000 inhabitants). Interregional inequalities in the allocation of health personnel have been studied through the correlation between the percentages of the health professions and the populations of the regions affected. RESULTS: In 2017, the number of health workers in all categories was 6608 in Mauritania, a ratio of 17.5 / 10000 health workers / inhabitants, ranging from 8.6 in "Gargot" wilaya to 37.3 in the wilaya of "Inchiri". The densities of specialist physicians, general practitioners, midwives and nurses were respectively 0.9, 0.84, 1.8, and 3.32 per 10,000 inhabitants, respectively. In the Nouakchott region, covering 28.5% of the Mauritanian population, 76.5% of specialist doctors and 56.8% of midwives, had ratios (health workers / 10 000 inhabitants) two and three times higher than national levels. CONCLUSION: This study documented on the one hand the persistence of the shortage of health personnel in Mauritania in 2017, in all its professional categories, and on the other hand the inequalities of their distribution in its administrative zones, with a relative abundance in the region of Nouakchott.

Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care.

OBJECTIVES: The aim of this study was to characterise the resources and challenges for surgical care and referrals at health centres (HCs) in South Wollo Zone, Ethiopia. SETTING: Eight primary HCs in South Wollo Zone, Ethiopia. PARTICIPANTS: Eight health officers and nurses staffing eight HCs completed a survey. DESIGN: The study was a survey-based, cross-sectional assessment of HCs in South Wollo Zone, Ethiopia and data were collected over a 30-day period from November 2014 to January 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: Survey assessed human and material resources, diagnostic capabilities and challenges and patient-reported barriers to care. RESULTS: Eight HCs had an average of 18 providers each, the majority of which were nurses (62.2%) and health officers (20.7%). HCs had intermittent availability of clean water, nasogastric tubes, rectal tubes and suturing materials, none of them had any form of imaging. A total of 168 surgical patients were seen at the 8 HCs; 58% were referred for surgery. Most common diagnoses were trauma/burns (42%) and need for caesarean section (9%). Of those who did not receive surgery, 32 patients reported specific barriers to obtaining care (91.4%). The most common specific barriers were patients not being decision makers to have surgery, lack of family/social support and inability to afford hospital fees. CONCLUSIONS: HCs in South Wollo Zone, Ethiopia are well-staffed with nurses and health officers, however they face a number of diagnostic and treatment challenges due to lack of material resources. Many patients requiring surgery receive initial diagnosis and care at HCs; sociocultural and financial factors commonly prohibit these patients from receiving surgery. Further study is needed to determine how such delays may impact patient outcomes. Improving material resources at HCs and exploring community and family perceptions of surgery may enable more streamlined access to surgical care and prevent delays.

The chiropractic workforce: a global review.

Background: The world is faced with a chronic shortage of health workers, and the World Health Organization (WHO) has estimated a global shortage of 7.2 million health workers resulting in large gaps in service provision for people with disability. The magnitude of the unmet needs, especially within musculoskeletal conditions, is not well established as global data on health work resources are scarce. Methods: We conducted an international, cross-sectional survey of all 193 United Nation member countries and seven dependencies to describe the global chiropractic workforce in terms of the availability (numbers and where they are practising), quality (education and licensing), accessibility (entry and reimbursement), and acceptability (scope of practice and legal rights). An electronic survey was issued to contact persons of constituent member associations of the World Federation of Chiropractic (WFC). In addition, data were collected from government websites, personal communication and internet searches. Data were analysed using descriptive statistics. Worldwide density maps of the distribution of numbers of chiropractors and providers of chiropractic education were graphically presented. Results: Information was available from 90 countries in which at least one chiropractor was present. The total number of chiropractors worldwide was 103,469. The number of chiropractors per country ranged from 1 to 77,000 (median = 10; IQR = [4-113]). Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 (90%) countries, and services were partially or fully covered by government and/or private health schemes in 46 (51.1%) countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries. Conclusion: We have provided information about the global chiropractic workforce. The profession is represented in 90 countries, but the distribution of chiropractors and chiropractic educational institutions, and governing legislations and regulations largely favour high-income countries. There is a large under-representation in low- and middle-income countries in terms of provision of services, education and legislative and regulatory frameworks, and the available data from these countries are limited.

Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana.

BACKGROUND: Basic inputs and infrastructure including drugs, supplies, equipment, water and electricity are required for the provision of quality care. In the era of the free maternal health policy in Ghana, it is unclear if such basic inputs are readily accessible in health facilities. The study aimed to assess the availability of basic inputs including drugs, supplies, equipment and emergency transport in health facilities. Women and health providers' views on privacy and satisfaction with quality of care were also assessed. METHODS: The study used a convergent parallel mixed methods in one rural municipality in Ghana, Kassena-Nankana. A survey among facilities (n = 14) was done. Another survey was carried out among women who gave birth in health facilities only (n = 353). A qualitative component involved focus group discussions (FGDs) with women (n = 10) and in-depth interviews (IDIs) with midwives and nurses (n = 25). Data were analysed using descriptive statistics for the quantitative study, while the qualitative data were recorded, transcribed, read and coded using themes. RESULTS: The survey showed that only two (14%) out of fourteen facilities had clean water, and five (36%) had electricity. Emergency transport for referrals was available in only one (7%) facility. Basic drugs, supplies, equipment and infrastructure especially physical space were inadequate. Rooms used for childbirth in some facilities were small and used for multiple purposes. Eighty-nine percent (n = 314) of women reported lack of privacy during childbirth and this was confirmed in the IDIs. Despite this, 77% of women (n = 272) were very satisfied or satisfied with quality of care for childbirth which was supported in the FGDs. Reasons for women's satisfaction included the availability of midwives to provide childbirth services and to have follow-up homes visits. Some midwives were seen to be patient and empathetic. Providers were not satisfied due to health system challenges. CONCLUSION: Government should dedicate more resources to the provision of essential inputs for CHPS compounds providing maternal health services. Health management committees should also endeavour to play an active role in the management of health facilities to ensure efficiency and accountability. These would improve quality service provision and usage, helping to achieve universal health coverage.

The Sufficiency of Health Care Professional Supply in Rural North Carolina.

For most health professions, rural North Carolina has lower relative supply than urban parts of the state. Although there are plenty of innovative models addressing this disparity, a holistic approach is necessary if we want to effect real change.

More health workers needed for universal health coverage.

Despite efforts to boost its health workforce, Bangladesh is struggling to make progress towards universal coverage of health services. Sophie Cousins reports.

Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.

Background: Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored. Methods: A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality. Results: The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients. Conclusions: The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.

[Dialogues on the work process in oral health in Brazil: an analysis based on the PMAQ-AB survey]. / Diálogos sobre o processo de trabalho em saúde bucal no Brasil: uma análise com base no PMAQ-AB.

The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.

Os objetivos do estudo foram: (1) descrever o processo de trabalho das equipes de saúde bucal (ESB) do Brasil, com base nos atributos essenciais da atenção primária à saúde, segundo regiões, tipo de equipe e características socioeconômicas dos municípios; e (2) verificar se os dados do processo de trabalho das ESB do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) foram capazes de aferir tais atributos. Estudo ecológico, de abrangência nacional, com dados do ciclo I do PMAQ-AB. Foram feitas análises descritivas, fatoriais exploratória e confirmatória (α = 5%). Os construtos formados foram analisados à luz dos atributos essenciais da atenção primária à saúde (primeiro contato, coordenação do cuidado, integralidade e longitudinalidade). Formaram-se os três primeiros construtos e um quarto fator, denominado ações em prótese dentária. Porém, o atributo longitudinalidade não foi conformado. As medidas de ajuste dos modelos foram satisfatórias. As cargas fatoriais foram maiores que 0,5, exceto para duas variáveis do fator 3. As ações mais realizadas pelas ESB (> 60%) foram as do primeiro contato e as menos comuns foram as da integralidade, destacando-se ter referência para especialidades (7,6%). Houve diferenças no processo de trabalho das ESB entre as regiões, tipo de equipe e estrato de certificação (p < 0,05). Conclui-se que os dados de processo de trabalho das ESB do ciclo I do PMAQ-AB foram capazes de discriminar três dos quatro atributos essenciais da atenção primária à saúde na rotina dos serviços. Sugere-se aprofundar a avaliação da longitudinalidade. Ademais, as ESB participantes do ciclo I do PMAQ-AB precisam avançar nas ações relacionadas à integralidade e coordenação do cuidado.

Los objetivos de este trabajo fueron: (1) describir el proceso de trabajo de los equipos de salud bucal (ESB) en Brasil, conforme los atributos esenciales de la atención primaria a la salud, según regiones, tipo de equipo y características socioeconómicas de los municipios; además de (2) verificar si los datos del proceso de trabajo de las ESB en el Programa Nacional de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) fueron capaces de evaluar tales atributos. Es un estudio ecológico, de cobertura nacional, con datos del ciclo I del PMAQ-AB. Se realizaron análisis descriptivos, factoriales exploratorios y confirmatorios (α = 5%). Los constructos creados se analizaron a la luz de los atributos esenciales de la atención primaria a la salud (primer contacto, coordinación del cuidado, integralidad y longitudinalidad). Se generaron los tres primeros constructos, y un cuarto factor, denominado acciones en prótesis dental. No obstante, el atributo longitudinalidad no se configuró. Las medidas de ajuste de los modelos fueron satisfactorias. Las cargas factoriales fueron mayores que 0,5, excepto en dos variables del factor 3. Las acciones más realizadas por las ESB (> 60%) fueron las de primer contacto, y las menos comunes fueron las de integralidad, destacándose contar con referencias para especialidades (7,6%). Hubo diferencias en el proceso de trabajo de las ESB entre las regiones, tipo de equipo y extracto de certificación (p < 0,05). Se concluye que los datos del proceso de trabajo de las ESB del ciclo I del PMAQ-AB fueron capaces de discriminar tres de los cuatro atributos esenciales de la atención primaria a la salud en la rutina de los servicios. Se sugiere profundizar en la evaluación de la longitudinalidad. Además, las ESB participantes del ciclo I del PMAQ-AB necesitan avanzar en acciones relacionadas con la integralidad y coordinación del cuidado.

Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery.

BACKGROUND: The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development. METHODS: This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included. RESULTS: There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate. CONCLUSIONS: Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems. LEVEL OF EVIDENCE: Epidemiologic study, level III.

The healthcare system and the provision of oral healthcare in European Union member states. Part 9: Sweden.

Equally accessible and affordable dental services for all population groups have been a political goal in Sweden for almost a century. All political parties have shared the idea that a person's social background should not have consequences for his or her dental status. Strategic tools to achieve this ambitious goal have been the wide use of publicly provided oral healthcare services, covering even sparsely populated areas, focusing on preventive care and significant subsidies for necessary treatments. Besides free care for children and young adults, oral healthcare is reimbursed from public funds. The public subsidy was particularly generous in 1975-1999 when a 'full clearance' of adults' dentitions was undertaken both by the public and private providers under fixed prices and high reimbursement levels for all treatment measures. Today, preventive oral healthcare for the elderly is given higher priority as most Swedes have been able to keep their natural teeth.

Critical Factors to Practicing Medical Acupuncture in Family Medicine: Patient and Physician Perspectives.

INTRODUCTION: Although an increasing number of physicians are completing medical acupuncture training, only half of those physicians are able to successfully incorporate acupuncture into practice. We conducted a qualitative study to identify the factors and barriers that can enhance and impede physicians' delivery of and patients' engagement in medical acupuncture within the family medicine clinic. METHODS: We conducted interviews with 15 family physicians and 17 patients in a US family medicine clinic that has integrated medical acupuncture into its practice. Audio recordings were transcribed and analyzed by 2 members of the study team in ATLAS.ti, using the constant comparative method. RESULTS: We identified 3 physician themes of factors/barriers that impact delivery/engagement: 1) patients' aversion to needles, 2) time challenges, and 3) access to resources. We identified 3 additional themes from patient interviews: 1) appointment access; 2) wanting noninvasive, no side effects alternative; and 3) openness to anything. DISCUSSION: The factors and barriers reported by physicians/patients help illustrate conditions needed to enhance physicians' ability to provide acupuncture and patients' willingness to engage and sustain it. Participants' experiences help to illustrate strategic approaches to managing these barriers-strategies that can be used by other individuals/institutions to enhance care delivery and patient engagement.

Barriers to and strategies for addressing the availability, accessibility, acceptability and quality of the sexual, reproductive, maternal, newborn and adolescent health workforce: addressing the post-2015 agenda.

BACKGROUND: In a post-2015 development agenda, achieving Universal Health Coverage (UHC) for women and newborns will require a fit-for-purpose and fit-to-practice sexual, reproductive, maternal, adolescent and newborn health (SRMNAH) workforce. The aim of this paper is to explore barriers, challenges and solutions to the availability, accessibility, acceptability and quality (AAAQ) of SRMNAH services and workforce. METHODS: The State of the World's Midwifery report 2014 used a broad definition of midwifery ("the health services and health workforce needed to support and care for women and newborns") and provided information about a wide range of SRMNAH workers, including doctors, midwives, nurses and auxiliaries. As part of the data collection, 36 out of the 73 participating low- and middle-income countries conducted a one-day workshop, involving a range of different stakeholders. Participants were asked to discuss barriers to the AAAQ of SRMNAH workers, and to suggest strategies for overcoming the identified barriers. The workshop was facilitated using a discussion guide, and a rapporteur took detailed notes. A content analysis was undertaken using N-Vivo software and the AAAQ model as a framework. RESULTS: Across the 36 countries, about 800 participants attended a workshop. The identified barriers to AAAQ of SRMNAH workers included: insufficient size of the workforce and inequity in its distribution, lack of transportation, user fees and out of pocket payments. In some countries, respondents felt that women mistrusted the workforce, and particularly midwives, due to cultural differences, or disrespectful behaviour towards service users. Quality of care was undermined by a lack of supplies/equipment and inadequate regulation. Against these, countries identified a set of solutions including adequate workforce planning supported by a fast and equitable deployment system, aligned with the principles of UHC. Acceptability and quality could be improved with the provision of respectful care as well as strategies to improve education and regulation. CONCLUSIONS: The number and scale of the barriers still needing to be addressed in these 36 countries was significant. Adequate planning and policies to support the development of the SRMNAH workforce and its equitable distribution are a priority. Enabling strategies need to be put in place to improve the status and recognition of midwives, whose role is often undervalued.

Diálogos sobre o processo de trabalho em saúde bucal no Brasil: uma análise com base no PMAQ-AB / Dialogues on the work process in oral health in Brazil: an analysis based on the PMAQ-AB survey / Discusiones sobre el proceso de trabajo en el ámbito de la salud bucal en Brasil: un análisis basado en el PMAQ-AB

Resumo: Os objetivos do estudo foram: (1) descrever o processo de trabalho das equipes de saúde bucal (ESB) do Brasil, com base nos atributos essenciais da atenção primária à saúde, segundo regiões, tipo de equipe e características socioeconômicas dos municípios; e (2) verificar se os dados do processo de trabalho das ESB do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) foram capazes de aferir tais atributos. Estudo ecológico, de abrangência nacional, com dados do ciclo I do PMAQ-AB. Foram feitas análises descritivas, fatoriais exploratória e confirmatória (α = 5%). Os construtos formados foram analisados à luz dos atributos essenciais da atenção primária à saúde (primeiro contato, coordenação do cuidado, integralidade e longitudinalidade). Formaram-se os três primeiros construtos e um quarto fator, denominado ações em prótese dentária. Porém, o atributo longitudinalidade não foi conformado. As medidas de ajuste dos modelos foram satisfatórias. As cargas fatoriais foram maiores que 0,5, exceto para duas variáveis do fator 3. As ações mais realizadas pelas ESB (> 60%) foram as do primeiro contato e as menos comuns foram as da integralidade, destacando-se ter referência para especialidades (7,6%). Houve diferenças no processo de trabalho das ESB entre as regiões, tipo de equipe e estrato de certificação (p < 0,05). Conclui-se que os dados de processo de trabalho das ESB do ciclo I do PMAQ-AB foram capazes de discriminar três dos quatro atributos essenciais da atenção primária à saúde na rotina dos serviços. Sugere-se aprofundar a avaliação da longitudinalidade. Ademais, as ESB participantes do ciclo I do PMAQ-AB precisam avançar nas ações relacionadas à integralidade e coordenação do cuidado.

Abstract: The study aimed to: (1) describe the work process in Brazil's oral health teams, based on the essential attributes of primary health care, according to geographic region, type of team, and the municipality's socioeconomic characteristics and (2) verify whether the data in the work process of the oral health teams in the Brazilian National Program to Improve Access and Quality in primary health (PMAQ-AB) were capable of measuring such attributes. This was a nationwide ecological study with data from cycle I of PMAQ-AB. The study included descriptive, exploratory factor, and confirmatory factor analyses (α = 5%). Constructs were analyzed in light of the essential attributes of primary health care (first contact, coordination of care, comprehensiveness, and continuity). The first three constructs and a fourth factor were formed, called dental prosthesis actions. However, the continuity attribute was not formed. The models' goodness-of-fit measures were satisfactory. Factor loads were greater than 0.5, except for the two variables in factor 3. The actions most frequently performed by the oral health teams (> 60%) were in first contact, and the least frequent were those in comprehensiveness, highlighting referrals to specialties (7.6%). There were differences in the work process in oral health teams between regions of the country, type of team, and certification strata (p < 0.05). In conclusion, data on the work process in oral health teams from cycle primary health care in the services' work routine. Further research is recommended on continuity of care. In addition, the oral health teams participating in cycle I of PMAQ-AB should make further progress in actions related to comprehensiveness and coordination of care.

Resumen: Los objetivos de este trabajo fueron: (1) describir el proceso de trabajo de los equipos de salud bucal (ESB) en Brasil, conforme los atributos esenciales de la atención primaria a la salud, según regiones, tipo de equipo y características socioeconómicas de los municipios; además de (2) verificar si los datos del proceso de trabajo de las ESB en el Programa Nacional de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) fueron capaces de evaluar tales atributos. Es un estudio ecológico, de cobertura nacional, con datos del ciclo I del PMAQ-AB. Se realizaron análisis descriptivos, factoriales exploratorios y confirmatorios (α = 5%). Los constructos creados se analizaron a la luz de los atributos esenciales de la atención primaria a la salud (primer contacto, coordinación del cuidado, integralidad y longitudinalidad). Se generaron los tres primeros constructos, y un cuarto factor, denominado acciones en prótesis dental. No obstante, el atributo longitudinalidad no se configuró. Las medidas de ajuste de los modelos fueron satisfactorias. Las cargas factoriales fueron mayores que 0,5, excepto en dos variables del factor 3. Las acciones más realizadas por las ESB (> 60%) fueron las de primer contacto, y las menos comunes fueron las de integralidad, destacándose contar con referencias para especialidades (7,6%). Hubo diferencias en el proceso de trabajo de las ESB entre las regiones, tipo de equipo y extracto de certificación (p < 0,05). Se concluye que los datos del proceso de trabajo de las ESB del ciclo I del PMAQ-AB fueron capaces de discriminar tres de los cuatro atributos esenciales de la atención primaria a la salud en la rutina de los servicios. Se sugiere profundizar en la evaluación de la longitudinalidad. Además, las ESB participantes del ciclo I del PMAQ-AB necesitan avanzar en acciones relacionadas con la integralidad y coordinación del cuidado.