Impact of risk assessment on the demand for dental services in Primary Health Care

Abstract

Background: The access to dental health services is a big problem in many parts of the world. The Primary Health Care proposes the organization of the access with equity and it can be done by stratification of risk and scale of vulnerabilities. The aim was to evaluate the impact of the implementation of risk classification tools to improve the access to dental health demand in Primary Health Care and to evaluate the effectiveness of implantation of the tool: risk classification and Coelho and Savassi's scale for organization of dental health service demand in one Primary Health Service in São Paulo city.Method: This was a cross-sectional study in which medical records (n = 1215) were evaluated before and after the implementation of the tool. The outcomes were 'immediate care', 'first dental appointment' and 'treatment completed', the independent variables were risk classification, Coelho and Savassi's scale, caries risk, periodontal disease, soft tissue, age and gender. Descriptive analyzes were performed comparing the variables of the study before and after the implantation of the tools (risk classification and "Coelho and Savassi" scale). Logistic Regression models and chi-square tests were performed to analyze these associations.Results: The most prevalent age group was 20 to 59 years old, 62.2% before and 59.4% after implantation. The main complaint of dental demand was pain. Regarding the "Coelho and Savassi" scale", 87.1% presented low social risk (R1), 8.5% medium risk (R2), 4.2% high risk (R3). The immediate care before implantation was 9.4% (n=56) and 39.9% (n=246) after implantation (p <0.001). The first dental appointment was 20.7% before implantation and 34.9% after the implantation (p <0.001). Regarding the treatment completed, there was an increase from 10% to 14.1% after the implantation of the tools (p = 0.001).Conclusions: The implementation of the tools 'risk classification and "Coelho and Savassi" scale' had impact in organization of odontological demand, with indicated an increase in the number of visits on the same day, first dental appointments and completed treatments. These results reinforce the importance of use of the tools to organize oral health care access. Background 4The access to dental services is still a problem in many places around the world. The ways in which the health systems are organized and social determinants are factors influencing the access to dental services, with effects on the population's oral health [1,2,3] Access is a big challenge in a universal health system, as oral health is necessary to ensure the comprehensiveness of care. Efforts seeking to broaden this access in an equitable manner are essential.In Brazil, for many decades, oral health care was typically sought by pregnant women and children, while other population groups accessed dental care services in emergency situations only, or did not access them [4]. Allied to this, the demographic and epidemiological transition, with population aging the increase in the number of non-communicable chronic disease...