Urgency and discontinuity of oral health care in children and adolescents. / Urgência e descontinuidade do cuidado em saúde bucal de crianças e adolescentes.

The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

Urgência e descontinuidade do cuidado em saúde bucal de crianças e adolescentes / Urgency and discontinuity of oral health care in children and adolescents

Resumo Este trabalho estudou a descontinuidade do cuidado (DC) em saúde bucal entre crianças e adolescentes que acessaram os serviços de urgência nas unidades básicas de saúde (UBS) e de pronto atendimento (UPA). Foram avaliados prontuários de indivíduos de 0 a 17 anos vinculados ao Sistema Único de Saúde de Curitiba. Considerou-se DC quando não houve o registro de consulta eletiva na UBS nos 6 meses subsequentes ao atendimento de urgência. A amostra foi estratificada pelo Índice de Desenvolvimento Humano Municipal (IDHM) da Unidade de Desenvolvimento Humano em que o paciente residia em ≤0,799 ou ≥0,800. A associação entre DC e demais covariáveis foi analisada através de regressão de Poisson com variância robusta uni e multivariada (α=0,05). A incidência de DC foi de 42,2%. No estrato de IDHM≤0,799, o risco de DC foi maior para as crianças com menos de 5 anos de idade e aqueles que não visitaram o dentista no último ano. Nos dois estratos, o risco de DC foi maior para aquelas que utilizaram a UPA para o atendimento de urgência quando comparadas com as que receberam atendimento na UBS. A DC em saúde bucal apresentou alta incidência, sendo que entre os residentes em regiões com menor IDHM, sofreu uma maior influência das características de uso dos serviços.

Abstract The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

Emergency Dental Care of Children and Adolescents in Basic Health Unit and Emergency Care Unit

Objective: To evaluate the factors related to the dental emergency care of children and adolescents in Basic Health Units (UBS) and Emergency Care Units (UPA) affiliated with the public dental network of Curitiba, Brazil. Material and Methods: Crosssectional study that evaluated 1,012 emergency cases in individuals aged up to 17 years old and with a permanent record in the Unified Health System of Curitiba. Demographic data of individuals and of services were taken from electronic medical records. Statistical analysis was performed using the chi-square test and chi-square test for linear trend (α = 0.05), estimating the prevalence ratio (PR) (95%CI). Results: Of the total of emergency cases, 68.2% and 31.8% were of children and adolescents, respectively. UBS accounted for 89.7% of the cases while UPA represented 10.3%, and 12.2% of the treatments were characterized as first access to the system. Adolescents used UPAs for emergency care more often than children (PR = 1.84; 95%CI: 1.28-2.64). Among children, those with more than 1 year since the last appointment used UPAs for emergency care more often (PR = 1.86; 95%CI: 1.09-3.17). Adolescents for whom emergency care was characterized as first access to the system used UPAs more often (PR = 2.16; 95%CI: 1.04-4.46). The proximity between the UBS of origin and the UPA was associated with greater UPA utilization by both groups. Conclusion: UBSs accounted for most of the dental emergency treatments. Children and adolescents with a poorer connection with UBSs and those who lived near an UPA had a higher prevalence of UPA utilization for emergency care.