Oral health in the family health strategy: a change of practices or semantics diversionism

Abstract

Oral health in the family health strategy: a change of practices or semantics diversionism Saúde bucal na estratégia de saúde da família: mudança de práticas ou diversionismo semântico ABSTRACT OBJECTIVE: To evaluate public health dentistry practices of two different family health models. METHODS:Qualitative study conducted with data obtained from focus groups consisting of 58 dentists working in the Family Health Strategy for at least three years between August-October, 2006. The Paideia Family Health Approach was used in the city of Campinas and the Oral Health Initiative as part of the Family Health Strategy was implemented in the city of Curitiba, Southeastern and Southern Brazil, respectively. Data was analyzed using the hermeneutic-dialectic method. Analysis indicators were employed to indicate backwardness, stagnation or progress in oral health practices effective from the implementation of the strategies referred. The indicators used were: work process; interdisciplinary approach; territorialization; capacity building of human resources; health promotion practices; and responsiveness to users' demands. RESULTS:There was progress in user access to services, humanization of health care, patient welcoming and patient-provider relationship. The results related to health promotion practices, territorialization, interdisciplinary approach and resource capacity building indicated a need for technical and operational enhancements in both cities. CONCLUSIONS:Both models have brought about important advances in terms of increased access to services and humanization of health care. Universal access to oral health at all levels of complexity was not achieved in both cities studied. Local health managers and oral health program coordinators must bring more weight to bear in the arena that defi nes public policy priorities. The main thematic issue of the present study is to assess changes in oral health practices following the implementation of the FHS in two Brazilian cities. It could be that political and administrative forces have contributed to the expansion of the changes desired, or either that the original essential proposal may have been disfi gured.The fi rst Brazilian programmatic dental policy was developed in the 1950s 7 and targeted exclusively at schoolchildren, and has become enrooted nationwide. RESUMOOBJETIVO: Avaliar práticas de saúde bucal coletiva de dois modelos de atenção à saúde familiar. MÉTODOS:Estudo qualitativo realizado por meio de grupos focais constituídos por 58 cirurgiões-dentistas atuantes em programa de saúde da família há pelo menos três anos. Foram adotados os modelos de atenção Método Paidéia em Saúde da Família (Campinas, SP, 34 profi ssionais) e Estratégia de Saúde da Família (Curitiba, PR, 24 profi ssionais). O estudo foi realizado entre os meses de agosto e outubro de 2006. O referencial teórico utilizado para análise dos dados foi a hermenêutica-dialética. Foram empregados indicadores analíticos visando a indicar retrocesso, estagnação ou progresso nas práticas de saúde bucal ...

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

“…Insufficient changes related to completeness were presented in five studies 18 , 32 , 36 , 43 , 45 (26.3%), which reported the introduction of care focused on the user, with a space for dialog and for the bringing together knowledge encompassing oral health. Unlike individual actions, the group actions and the advances in the preventive view and the practice of health education of professionals were expressive in FHCT.…”

“… 19 Even with the extended access to oral health care services, organizing the demand was a critical bottleneck, as there are several gateways, large repressed demand, and little supply. 19 , 32 , 34 Increasing and improving care requires facing challenges related to insufficient public investments; to the difficulties in referring patients to specialty services; the actions focusing on clinical care with excess emphasis on technique and specialty; and the rising demand for services by the population, focused on healing actions. 34 Despite the difficulties, we observed positive aspects in the studies: limiting of clients, enabling better supervision; changes in the profile of dental procedures conducted; and population-based coverage according to the minimum limit as per the Ministry of Health.…”

“…These elements were mentioned by seven studies. 5 , 10 , 32 , 34 , 45 - 47 Among those, six pointed out changes: the influence of new national syllabus guidelines in the more humanized practice of dentists, reinforcing the bond, the extended look at the territory and the community; and the potential work of community health care agent in the establishment of bonding, welcoming, and autonomy of users. 5 , 47 …”

“…59 Although results are nationally satisfactory, some factors call our attention: (a) regional differences in the prevalence and seriousness of caries are distinctive, which indicates a need for policies focused on equal care; (b) small reduction of caries in deciduous dentition (18.0%) and 80.0% of affected teeth remaining untreated; (c) significant deficit for older adults, despite adolescents’ and adults’ need for prosthetics having been decreased; and (d) prevalence of malocclusion requiring treatment in 10.0% of adolescents, which suggests a need for resizing the supply of dental procedures in secondary care. 32 , 33 These results are associated with the profile of dental practice, characterized by the conduction of eminently clinical actions emphasizing restoring activities and preventive actions focusing on students, which were shown to be insufficient to meet the needs of the population. 31 …”

“…59 Embora os resultados sejam satisfatórios nacionalmente, chamam a atenção: (a) diferenças regionais na prevalência e gravidade da cárie são marcantes, o que indica necessidade de políticas voltadas para a equidade na atenção; (b) pouca redução da cárie na dentição decídua (18,0%) e 80,0% dos dentes afetados continuam não tratados; (c) o déficit em idosos é significativo, apesar das necessidades de próteses terem diminuído em adolescentes e adultos; e (d) prevalência de oclusopatia que requer tratamento em 10,0% dos adolescentes, o que sugere a necessidade de redimensionar a oferta de procedimentos ortodônticos na atenção secundária. 32 , 33 Esses resultados estão associados ao perfil da prática odontológica, caracterizado pela realização de ações eminentemente clínicas, com ênfase em atividades restauradoras, e ações preventivas direcionadas a escolares, que se mostraram insuficientes para responder às necessidades da população. 31 …”