Role of management and human resource factors on matrix support in secondary oral health care in Brazil

Abstract

Objectives To investigate the association between health management and human resource factors on matrix support (MS) in a nationally representative sample of Dental Specialty Centres (DSCs) in Brazil. Methods This survey included 1042 DSCs (Response rate = 94.99%) in the second cycle of the National Program for the Improvement of the Quality and Access to the Dental Specialty Centres (PMAQ‐CEO, in Portuguese) in 2018. Previously trained interviewers extracted information on MS, health management and human resources of the DSC by using a structured instrument. An MS score was created by adding the number of positive answers to the 10 MS questions. Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios (RR) and corresponding 95% confidence interval (CI). Results Of all the DSCs (n = 1042), 116 (11.1%) performed all 10 MS procedures. Those DSCs with a manager who had a higher education degree in the area of Public Health or Public Management (RR = 1.01, 95% CI, 1.01–1.02) and with human resources that received incentives, bonuses or financial awards for performance related to the PMAQ‐CEO result (RR = 1.01 95% CI 1.01–1.02) are more likely to perform MS, when compared to the reference categories. The DSCs that are more likely to perform MS include those that developed actions as a result of periodic planning and evaluation with confirmatory documentation (RR = 1.06, 95% CI; 1.01–1.10); those that received support for planning and organizing the work scheme (RR = 1.03, 95% CI; 1.01–1.05); those that monitored and analysed the goals set for each specialty offered at the DSC, with (RR = 1.06, 95% CI; 1.01–1.10) or without confirmatory documentation (RR = 1.06, 95%CI; 1.02–1.11); those whose team periodically performed self‐assessment processes, using the Ministry of Health's formal self‐assessment (AMAQ in Portuguese) (RR = 1.04, 95% CI; 1.02–1.05); those who followed clinical guidelines (with confirmatory documentation) regarding the referral of patients from primary care to the DSC (RR = 1.02, 95% CI; 1.01–1.04). On the contrary, DSCs that did not use the results achieved in previous PMAQ cycles in the organization of the DSC's team work scheme proved to be less likely to perform MS (RR = 0.98, 95% CI; 0.96–0.99). Conclusions Matrix support is associated with human resources and management factors in secondary oral health care in Brazil. Continuing professional development and some management characteristics are important for secondary dental care quality and could be considered in health policy initiatives.

Association between management, human resources, and care provided to patients with special healthcare needs in dental specialty centers in Brazil: A cross‐sectional study

“…Each "unfavorable" answer scored zero. [16][17][18] The reliability estimate, based on The Cronbach's alpha coefficients, was 0.726. The exclusion of each of 23 items were also tested, and Cronbachťs alpha coefficients ranged from 0.701 to 0.758.…”

“…Recent publications have used the same approach that used in our manuscript. [16][17][18] The reliability of our outcome, measured by the Cronbach's alpha coefficients, is considered adequate. 20 The heterogeneity and low scores of the performance of secondary dental care provided to SHCN patients in Brazil have some possible explanations.…”

“…Studies have shown that when there are financial incentives, the number of dental procedures increases considerably, and the goals are met. 17,27 Thus, it becomes evident just how necessary it is to have proper evaluation, planning, and management within the Unified Health System (SUS). 35 Some limitations, however, should be pointed out.…”

Estudo de avaliabilidade da atenção especializada em saúde bucal no sistema público de saúde brasileiro

“…Os CEO estão em funcionamento há 18 anos e já passaram por algumas avaliações, em âmbito governamental e educacional (Abreu et al, 2022;Brasil, 2020;Goes et al, 2022;Pinto et al, 2022). Contudo, nenhuma dessas avaliações foram estudos de avaliabilidade, os quais em sua essência contariam com a participação dos envolvidos e permitiriam mudanças no foco do gerenciamento, assim como no desenvolvimento e aprimoramento dos futuros processos avaliativos.…”

Regulation of dental consultations in primary health care and performance of services in Dental Speciality Centers

“…They work in line with Primary Health Care, ensuring the interface with the health system according to the city's epidemiological reality 1 and patient needs. The main problems in the functioning of patient regulation in CEOs are the absence of protocols that guide professionals on when and how to refer the patient, the high rate of absenteeism and evasion, and the large number of people who seek dental care directly in CEOs, without going to the PHC before [2][3][4][5] .…”