Clinical Analysis of Management Aspects of Centers for Dental Specialties

Objective: To evaluate the different management aspects of Centers for Dental Specialties (CEO) in Brazil. Material and Methods: Quantitative study with analysis of secondary data. The results of external evaluation of the first PMAQ-CEO cycle were considered, especially those related to planning and self-assessment, demand organization, work process, human resources as well as the availability of supplies/materials/dental equipment. The selected data were analyzed based on the calculation of proportions using the Microsoft Office Excel and Statistical Package for the Social Sciences (SPSS) programs. Results: The planning of actions in CEOs is conducted in nearly 80% of units, with the participation of dental surgeons, receiving support, mainly, from the local dental health or state public manager. The access to CEO is given, mostly, in a referenced or mixed (referenced and spontaneous) form. Only 49% of CEOs offer permanent education actions for workers. The work management process has been guided by quality standards of PMAQ-CEO for 77% of managers. Conclusion: The study allowed perceiving the presence of an often shared management, on the CEO organization, on self-evaluation process, planning, demand organization and work process, as well as human resources and infrastructure, showing conformity with the Oral Health National Policy guidelines. However, the results show that some problems with regard to the evaluation as work routine and management of access to CEOs still persist, pointing to the need for further studies and effort of managers to overcome them.

Appointment Failure among Dental Patients Attending a Government Dental Centre in Enugu, Nigeria

Objective: To evaluate the prevalence and socio demographic factors associated with failed dental appointments among dental patients in a government dental clinic. Material and Methods: This was a cross-sectional study of 419 participants who were non-first clinic attendees at a government dental clinic in Enugu, Nigeria. Data was collected on socio-demographic profile, mode of transportation and reasons for failed appointment, using a pretested structured questionnaire. Bi-variate analysis was conducted to test the association between study participants' age, sex, occupation, mode of transportation and failed dental appointment using Chi-square test and p<0.05 was considered significant. Results: The age of the study participants ranged from 5 years to 90 years. More females (57.8%) than males (42.2%) participated in the study. The prevalence of failed appointment was 27.7%. The major reasons for failed appointments were "being busy with other activities" (12.4%) and "far distance" (6.9%). Only 0.7% of the study participants received telephone calls as reminder. There was no statistically significant association between age (p=0.40), sex (p=0.12), level of education (p=0.40), occupation (p=0.52), mode of transportation (p=0.71) and failed dental appointment. Conclusion: The prevalence of failed dental appointment was high in this population. Being busy and far distance were the commonest reasons for failed appointments. Very few study participants were reminded of their appointment.

Satisfaction, Resolution and Social Participation of users of Centers for Dental Specialties in Brazil: A PMAQ-CEO Analysis

Objective: To describe satisfaction, resolution and social participation of users regarding the service offered in Brazilian Centers for Dental Specialties (CEOs). Material and Methods: An analysis was made of the first phase of PMAQ-CEO, developed during 2014, in which 8,897 users were interviewed. Module III of the instrument external evaluation was used, considering the socio-demographic characterization of the assisted population, and an analysis of satisfaction, resolution and social control of Brazilian CEOs. The bivariate and multivariate Poisson regression analysis with robust variance was used (α<0.05). Results: The profile of interviewed users is female, from the Northeastern region, brown color, living in the urban zone, incomplete elementary school, income of up to two minimum wages and resident of area covered by the family health strategy. The overall CEO rating is "good" (46.1%) or "very good" (49.2%). The score (0 to 10) given to reception staff and dentists was, respectively, 9.31±1.32 and 9.52±1.02. Among subjects who completed treatment (33.3%), the resolution was 95.3%. Although 89.1% stated they never needed to file a complaint, 68.4% did not know the Unified Health System ombudsman. The positive evaluation of CEO was associated with the good evaluation of professionals involved (p<0.05) and the absence of treatment interruption due to lack of material (p=0.037). Conclusion: The satisfaction of users with the services of Centers for Dental Specialties is high and treatments offered are resolutive. Social control tools need to be better known by users.

Implementation of dental specialty centers: a descriptive analysis of the current status in the Brazilian territory

ABSTRACT This study aimed to assess the current implementation status of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEO) in Brazil. The sample included CEOs implemented up to November 2015 in the 27 Brazilian federative units. Data were obtained directly from the database of the Informatics Department of the Brazilian Unified Health System, according to the National Registry of Health Facilities (NRHF) of Dental Specialty Centers of all Brazilian regions. Primary care data were also collected from the cities with implemented CEOs, including coverage status of the Family Health Strategy (FHS) and number of Oral Health Teams (OHT) I and II, at 2 collection periods (January 2006 and November 2015). There were 1019 CEOs implemented in Brazil, which were unequally distributed among the Brazilian states, with prevalence of implementation of CEOs type II (n=503, 49.4%). The statistical analysis showed significant difference between the three types of CEO (I, II, and III) and the variables of coverage rate (FHS) and number of teams (OHT I, OHT II) at both data collection periods. Although presenting an evolutionary aspect in the implementation of CEOs, the implementation of medium-complexity care in Brazil is disorganized.

Implementation of dental specialty centers: a descriptive analysis of the current status in the Brazilian territory.

This study aimed to assess the current implementation status of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEO) in Brazil. The sample included CEOs implemented up to November 2015 in the 27 Brazilian federative units. Data were obtained directly from the database of the Informatics Department of the Brazilian Unified Health System, according to the National Registry of Health Facilities (NRHF) of Dental Specialty Centers of all Brazilian regions. Primary care data were also collected from the cities with implemented CEOs, including coverage status of the Family Health Strategy (FHS) and number of Oral Health Teams (OHT) I and II, at 2 collection periods (January 2006 and November 2015). There were 1019 CEOs implemented in Brazil, which were unequally distributed among the Brazilian states, with prevalence of implementation of CEOs type II (n=503, 49.4%). The statistical analysis showed significant difference between the three types of CEO (I, II, and III) and the variables of coverage rate (FHS) and number of teams (OHT I, OHT II) at both data collection periods. Although presenting an evolutionary aspect in the implementation of CEOs, the implementation of medium-complexity care in Brazil is disorganized.

[Multidisciplinary approach to oral rehabilitation in wounded fighters].

Maxillofacial injuries during military service and in operations in particular, often involve soft and hard tissues, including fractures of bone and teeth. This kind of injury demands a multidisciplinary approach including specialists in oral and maxillofacial surgery periodontists, endodontics, orthodontics and prosthodontics. A comprehensive therapy is achieved by a complete cooperation between the disciplines for a long-term. We present a case report of a complex oral rehabilitation of a fighter wounded in "Zuk Eitan" operation, as an example of the multidisciplinary approach in our department.

Avaliação dos serviços públicos de Endodontia nos Centros de Especialidades Odontológicas de Minas Gerais / Assessment of public services in Endodontics in Dental Specialties Centers of Minas Gerais, Brazil

Objetivo do estudo foi avaliar serviços de Endodontia na atenção secundária dos Centros de Especialidades Odontológicas (CEO) de Minas Gerais (MG), em 2014. Dados de produtividade foram extraídos do TABWIN, segundo Cadastro Nacional de Estabelecimento de Saúde dos CEO/MG. Variáveis de caracterização dos municípios (porte populacional, IDH, Índice de Gini), e dos serviços (cobertura PSF, tempo de credenciamento, tipo de CEO, produtividade) foram extraídas do IBGE e DATASUS. Avaliação dos gestores de saúde bucal dos municípios foi feita por um questionário. Análise descritiva e Correlação de Spearman foram realizadas a um nível significância de 5%. Distribuídos por 70 municípios, 76 CEO credenciados compuseram amostra, dos quais 65,8% eram tipo II. Tempo mediano de credenciamento foi 8 anos. A maioria das cidades apresentou porte populacional <50 mil habitantes (39,4%), IDH e Índice de Gini com 52,6% e 65,8%, respectivamente, acima da mediana e 93,4% das cidades com cobertura de PSF ≥ 50%. Endodontia de dentes unirradiculares apresentou maior mediana de produção, seguidos pelos trirradiculares e birradiculares, mas a maioria dos CEO não atingiu metas de produtividades estabelecidas pelo Ministério da Saúde (MS) e 52,63% alcançaram metas em menos de 25% dos meses disponíveis para análise. Houve correlação positiva, respectivamente, entre total de procedimentos de endodontia e média mensal de produtividade e porte populacional (p = 0,006; p = 0,003) e tipo de CEO (p= 0,004; p = 0,001); além de porcentagem de meses com meta alcançada e porte populacional (p = 0,015) e número de meses com meta alcançada e número de meses disponíveis para análise de produção (p=0,011). Houve retorno de 94,29% dos questionários dos gestores, a maioria era dentista (89,4%) e estava há mais de 2 anos no cargo (53%). A maioria das cidades tinha apenas um CEO em funcionamento (92,4%) com 2 dentistas (30,3%). Em 87,9% das cidades, endodontia era realizada apenas no CEO. Assistência em endodontia a outros municípios foi observada em 69,7% dos CEO, sendo 59,1% municípios da mesma microrregião de saúde. Haviam protocolos de referenciamento da atenção primária para CEO em 87,9% da amostra e, destes, 37,9% tinham protocolo municipal próprio e 34,8% seguiam o do MS. A maioria dos CEO tinha lista de prioridades no atendimento (65,2%) e 84,8% tinham meta de produtividade a seguir, sendo que 60,6% destes seguiam metas do MS. Em 50% dos CEO, tempo de espera para início da endodontia foi 1-6 meses. A maioria dos CEO não tinha recursos tecnológicos (42%) para endodontia e, após conclusão desta, 50% dos pacientes eram contra referenciados à atenção primária. Houve uma correlação positiva entre o número de dentistas que realizaram tratamento endodôntico no CEO com o total de procedimentos endodônticos (p=0,0013) e porcentagem de meses com meta alcançada (p=0,029); e correlação negativa entre recursos tecnológicos disponíveis com total de procedimentos endodônticos (p=0,010) e porcentagem de meses com meta alcançada (p=0,012). A maioria dos serviços de Endodontia nos CEO avaliados não alcançaram as metas. Observou-se que gestores desconhe

Aim of this study was to evaluate Endodontics services in secondary care of the Dental Specialties Centers (DSC) of Minas Gerais (MG), during 2014. Outputs were collected from TABWIN, according to National Register of Health Establishment of the DSC of MG. Variables of municipalities characterization (population size, Human Development Index (HDI), Gini Index) and services (Family Health Program (FHP) coverage, accreditation, type of DSC, output) were extracted from the IBGE and DATASUS. Assessment of oral health managers of municipalities was done through a questionnaire. Descriptive analysis and Spearman correlation were performed, considering 5% significance level. Spread over 70 cities, 76 accredited DSC composed the sample, of which 65.8% were type II. Accreditation median time of DSC was 8 years. Most cities showed population size less than 50 thousand inhabitants (39.4%), HDI and Gini Index with 52.6% e 65.8%, respectively, above the median and 93.4% of the cities with FHP coverage above 50%. Single-rooted teeth' endodontics showed the highest median production, followed by multi- and birradiculars teeth. Most DSC did not reach output target established by the Brazilian Ministry of Health (MofH) and 52.63% achieved targets in less than 25% of available months for analysis. There was a positive correlation, respectively, between a total of endodontic procedures and monthly mean of productivity and population size (p = 0.006; p = 0.003) and DSC type (p = 0.004; p = 0.001); besides of percentage of months with targets reached and population size (p = 0.015); and number of months with achieved target and number of available months for production analysis (p = 0.011). There was return of 94.29% of the managers' questionnaires, most had graduated in Dentistry (89.4%) and were more than two years in post (53%). Most cities had only one operating DSC (92.4%) with two dentists (30.3%). Endodontic treatments were performed exclusively in DSC (87.9%), and in 69.7% of DSC there was demand for endodontics assistance from other municipalities, being 59.1% from the same health microregion. There were referencing protocols from primary to secondary care in 87.9% of DSC, where 37.9% followed their own municipal protocol and 34.8% the MofH protocol. Most DSC had priorities list in attendance (65.2%) and 84.8% had one following output target, and 60.6% of these followed goals of MofH. In 50% of DSC, waiting time for start of endodontics was 1-6 months. Most DSC did not have technological resources (42%) to endodontic treatments and, after conclusion of endodontic treatment, 50% of patients were counter-referred to primary care. There was positive correlation between number of dentists that performed endodontic treatments in the DSC with total endodontics procedures (p = 0.013) and percentage of months with target reached (p = 0.029); and negative correlation between available technological resources with total endodontics procedures (p = 0.010) and percentage of months with target reached (p = 0.012). Most endodontics services in evaluated DSC did not achieve targets. It noted that some managers unaware principles of the MofH, demanding that management measures and targets must be reevaluated

Avaliação da atenção secundária em saúde bucal do Centro de Especialidades Odontológicas de Pelotas, Rio Grande do Sul, 2012-2013 / Evaluation of Secondary Dental Health Care at the Dental Specialties Centre, Pelotas, Rio Grande do Sul, Brazil, 2012-2013 / Evaluación de la Atención Secundaria de Salud Bucodental del Centro de Especialidades, Pelotas, Rio Grande do Sul, en el período 2012-2013

OBJETIVO: avaliar a estrutura, o processo de cuidado e os resultados na endodontia, periodontia e cirurgia realizadas pelo Centro de Especialidades Odontológicas (CEO) de Pelotas-RS. MÉTODOS:foi realizado estudo transversal; avaliou-se o número de profissionais e equipos odontológicos do CEO, a forma de encaminhamento e agendamento e o manejo do absenteísmo; caracterizou-se a demanda e os encaminhamentos para a central de regulação no período de julho/2012 a junho/2013. RESULTADOS: foram atendidos 940 usuários e realizados 1.502 procedimentos, com 76,0% de tratamentos concluídos; o tempo médio de espera por atendimento foi de dois meses; 13% dos usuários encaminhados desistiram do tratamento; e existiam 849 usuários na fila de espera. CONCLUSÃO: o CEO/Pelotas-RS ficou aquém dos parâmetros de produção exigidos pelo Ministério da Saúde e precisa ampliar sua produção; a central de regulação necessita de protocolos que orientem as prioridades no atendimento; ademais, são necessários novos CEO no município.

OBJETIVO: evaluar la estructura, el proceso y los resultados en la endodoncia, periodoncia y cirugía del Centro de Especialidades Odontológicas (CEO) de Pelotas/RS. MÉTODOS: se hizo un estudio transversal; se evaluó el número de profesionales y equipos odontológicos del CEO, la forma de derivación y el marcado de consultas, y el manejo del absentismo; se caracterizaron la demanda y las remisiones para la central de regulación en el período de julio del 2012 a junio del 2013. RESULTADOS: se atendieron 940 usuarios y se realizaron 1502 procedimientos, con 76% de tratamientos concluidos; el promedio de espera por atención fue de 2 meses, el 13% de los usuarios abandonó el tratamiento y había 849 usuarios en espera. CONCLUSION: el CEO está por debajo de los parámetros de producción exigidos por el Ministerio de Salud y necesita adecuarlos; la central de regulación necesita protocolos que orienten las prioridades en la atención; además, la ciudad necesita nuevos CEOs.

OBJECTIVE: to evaluate the structure, care process and results of the endodontics, periodontics and surgery services at the Pelotas/RS Dental Specialties Centre (DSC). METHODS: this was a cross-sectional study; an evaluation was made of the number of dental professionals and teams at the DSC, forms of referral and appointment making and no-show management; demand for services and referral to the appointment control centre between July 2012 and June 2013 were characterized. RESULTS: 940 service users received care and 1,502 procedures were performed; 76.0% of procedures were concluded; average waiting time was 2 months; 13% of service users referred did not complete treatment and 849 were on the waiting list. CONCLUSION: DSC did not meet Ministry of Health required productivity parameters and needs to increase production; the appointment control centre needs protocols to guide care prioritization; moreover, the municipality needs additional DSCs.

Access to dental care and the capacity of the California dental care system.

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

A review of effective methods of delivery of care: skill-mix and service transfer to primary care settings.

AIMS: Health policy in England is seeking to minimise hospital use and provide access to services in a primary healthcare setting and maximise skill-mix, driven by issues such as cost and access. The aim of this review was to determine the effectiveness of increased use of skill-mix and service transfer within general and oral healthcare. Secondary outcome measures were related to cost, quality, access, health outcomes and satisfaction. METHODS: Data sources were the Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination DARE, British Nursing Index, CINAHL, EMBASE, MEDLINE, and PsycINFO from 1996 to August 2008. The reference lists of relevant papers were scanned to identify additional studies. DATA SELECTION: A rapid appraisal of systematic reviews, randomised controlled trials, controlled trials and service evaluations in relation to specialist services, practitioners with a special interest, medical and dental, nursing and dental care professionals, together with evidence of service shifts from secondary to primary care was undertaken. RESULTS: A total of 206 papers were reviewed. All titles and abstracts of articles and papers found were extracted and validated according to predefined criteria. They were screened for relevance by two researchers, who assessed trial quality and extracted data. Twenty-six papers met the inclusion criteria. The literature demonstrated limited evidence of the cost-effectiveness and health outcomes associated with changes in setting and skill-mix. However, there was evidence of improved access, patient and professional satisfaction. CONCLUSIONS: There is an overwhelming need for well-designed interventions with robust evaluation to examine cost-effectiveness and benefits to patients and the health workforce.