Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

Abstract

Objective Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services. Methods Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011–2012 and Cycle II: 2013–2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made. Results The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was "Best completeness" in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with "Best completeness" increased by 89.1%, the one with "Worst completeness" increased by 20%, while those with "Average completeness" decreased by 66.3%. Conclusion We identified positive changes in the indicators of potential access to oral health services, expanding the users’ ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.

Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis

“…This finding is in accordance with an ecological study that evaluated the structure and work process of primary dental care services using data from the PMAQ of PHC (1st and 2nd Cycles), that showed that the number of primary care teams that made appointments every day of the week increased by 8.7% and that those that provided home visits increased from 44.1% to 52.9%. Also, there was a reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.4% to 60.1% and in the continuity of treatment, varying from 63.4% to 61.1% 23 …”

“…The evaluation of work processes comprise aspects that include governance, service organization, and planning 21 . Quality improvement programmes based on P4P are uncommon in Dentistry, but are somewhat popular in medicine, especially in PHC 19,22,23 …”

“…21 Quality improvement programmes based on P4P are uncommon in Dentistry, but are somewhat popular in medicine, especially in PHC. 19,22,23 They may contribute importantly to improve services and providers' performance in critical indicators related to OC diagnosis and management, and can potentially reduce disease burden. Notwithstanding, we have not found previous studies evaluating the findings of large-scale programmes based on P4P in OC care work processes.…”

Latent transition analysis of cardiac arrest patients treated in the intensive care unit

“…However, it is largely unknown whether the subphenotypes are stable or subject to transitions and how could this transition inform clinical decisions. Other studies show that subphenotype transition can have significant clinical implications [ 17 , 22 ]. Thus, the current study aimed to characterize the latent transition pattern of CA patients by using latent transition analysis (LTA).…”

“…Gårdlund B and colleagues identified 6 subphenotypes of septic shock that showed distinct clinical characteristics [15]. In addition, the subphenotype transition has also been widely investigated because unraveling the transition pattern can have significant clinical and research implications [16][17][18]. For example, subphenotype stability over time can help to design trials and/or therapeutics.…”