Assessment of Public Oral Healthcare Services in Curitiba, Brazil: a Cross-sectional Study Using the Primary Care Assessment Tool (PCATool)

Overview

Journal BMJ Open

Specialty General Medicine

Date 2019 Jan 20

PMID 30659038

Citations 3

Authors

Antonio Carlos Nascimento

Simone Tetu Moyses

Renata Iani Werneck

Marilisa Carneiro Leao Gabardo

Samuel Jorge Moyses

Affiliations

Soon will be listed here.

Abstract

Objectives: To compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as 'conventional' healthcare (CHC), regarding the presence and extent of the attributes of 'good' primary healthcare (PHC). The null hypothesis of this study is that the attributes do not differ between the FHS and CHC.

Design: Cross-sectional.

Setting: Public PHC services in Curitiba, the state capital of Paraná.

Participants: PHC users of the public oral health network (n=900) and dentists active in this municipal network (n=203).

Primary And Secondary Outcome Measures: The Primary Care Assessment Tool (PCATool)-Dentists and PCATool-Users were used to analyse the primary outcomes ('essential' attributes) and secondary outcomes ('derived' attributes) in the PHC.

Results: Overall, the primary care services in oral health were well evaluated, both by users and by dentists, with mean scores ascribed to PHC attributes mostly above the cut-off point (6.6). The exception for users were affiliation (6.36; 95% CI 6.11 to 6.60) and accessibility (5.83; 95% CI 5.78 to 5.89); and for dentists the accessibility (5.80; 95% CI 5.63 to 5.96). When comparing FHS and CHC, there was a superiority of the FHS model, which reached a general mean score of 7.53 (95% CI 7.48 to 7.58) among users and 7.56 (95% CI 7.45 to 7.67) among dentists; on the other hand, the CHC general mean score was of 6.61 (95% CI 6.49 to 6.73) and 6.68 (95% CI 6.56 to 6.80) respectively for users and dentists.

Conclusions: The results reveal a reasonable level of attainment of PHC attributes in the services investigated. Nevertheless, public health managers should make efforts to reduce the difficulties faced by users in accessing dental care. The more positive results achieved by FHS services indicate that the provision of oral healthcare under this strategy should be expanded.

Citing Articles

From Clinics to Communities: Understanding Public Perceptions of Dental Services in Pakistan.

Ali K, Zahra D, Bashir U, Raja H, Alkhtib A, Younas M Health Expect. 2025; 28(1):e70177.

PMID: 39967288 PMC: 11836344. DOI: 10.1111/hex.70177.

Evolution of orthodontic services in the Brazilian Unified Health System: a time series analysis (2011-2022).

Teixeira da Silva D, de Avila N, Oliveira L, Bulgareli J, Paranhos L, Herval A BMC Oral Health. 2024; 24(1):1375.

PMID: 39543622 PMC: 11566891. DOI: 10.1186/s12903-024-05146-0.

Attributes of primary health care in Mato Grosso do Sul state: PCAT-Brazil paired for users and health professionals, 2018.

Bomfim R, Leite H, Zafalon E, De-Carli A, Santos M BMC Health Serv Res. 2022; 22(1):972.

PMID: 35906576 PMC: 9338599. DOI: 10.1186/s12913-022-08363-x.

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

Ribeiro A, Martins R, Vissoci J, da Silva N, Augusto Hernandes Rocha T, Queiroz R PLoS One. 2021; 16(3):e0247101.

PMID: 33725008 PMC: 7963056. DOI: 10.1371/journal.pone.0247101.

References

Leake J, Birch S . Public policy and the market for dental services. Community Dent Oral Epidemiol. 2008; 36(4):287-95. DOI: 10.1111/j.1600-0528.2008.00438.x. View

Garcha V, Shetiya S, Kakodkar P . Barriers to oral health care amongst different social classes in India. Community Dent Health. 2010; 27(3):158-62. View

Harzheim E, Starfield B, Rajmil L, Alvarez-Dardet C, Stein A . [Internal consistency and reliability of Primary Care Assessment Tool (PCATool-Brasil) for child health services]. Cad Saude Publica. 2006; 22(8):1649-59. DOI: 10.1590/s0102-311x2006000800013. View

Appleby J . Dentistry: should it be in the NHS at all?. BMJ. 2016; 355:i5986. DOI: 10.1136/bmj.i5986. View

Rasella D, Aquino R, Santos C, Paes-Sousa R, Barreto M . Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet. 2013; 382(9886):57-64. DOI: 10.1016/S0140-6736(13)60715-1. View

Macinko J, Souza M, Guanais F, da Silva Simoes C . Going to scale with community-based primary care: an analysis of the family health program and infant mortality in Brazil, 1999-2004. Soc Sci Med. 2007; 65(10):2070-80. DOI: 10.1016/j.socscimed.2007.06.028. View

Nascimento A, Moyses S, Cesar Bisinelli J, Moyses S . Oral health in the family health strategy: a change of practices or semantics diversionism. Rev Saude Publica. 2009; 43(3):455-62. DOI: 10.1590/s0034-89102009000300009. View

Alencar M, Coimbra L, Morais A, Silva A, Pinheiro S, Queiroz R . [Evaluation of the family focus and community orientation in the Family Health Strategy]. Cien Saude Colet. 2014; 19(2):353-64. DOI: 10.1590/1413-81232014192.08522012. View

Watt R . Social determinants of oral health inequalities: implications for action. Community Dent Oral Epidemiol. 2012; 40 Suppl 2:44-8. DOI: 10.1111/j.1600-0528.2012.00719.x. View

10.

Harnagea H, Lamothe L, Couturier Y, Esfandiari S, Voyer R, Charbonneau A . From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care. BMC Oral Health. 2018; 18(1):23. PMC: 5815219. DOI: 10.1186/s12903-018-0484-8. View

11.

Nesbitt R, Lohela T, Soremekun S, Vesel L, Manu A, Okyere E . The influence of distance and quality of care on place of delivery in rural Ghana. Sci Rep. 2016; 6:30291. PMC: 4978958. DOI: 10.1038/srep30291. View

12.

Cassady C, Starfield B, Hurtado M, Berk R, Nanda J, Friedenberg L . Measuring consumer experiences with primary care. Pediatrics. 2000; 105(4 Pt 2):998-1003. View

13.

Nascimento A, Moyses S, Werneck R, Moyses S . Oral health in the context of primary care in Brazil. Int Dent J. 2013; 63(5):237-43. PMC: 9375030. DOI: 10.1111/idj.12039. View

14.

Williams D, Sheiham A, Watt R . Oral health professionals and social determinants. Br Dent J. 2013; 214(9):427. DOI: 10.1038/sj.bdj.2013.436. View

15.

Atchison K, Weintraub J, Rozier R . Bridging the dental-medical divide: Case studies integrating oral health care and primary health care. J Am Dent Assoc. 2018; 149(10):850-858. DOI: 10.1016/j.adaj.2018.05.030. View

16.

Willie-Stephens J, Kruger E, Tennant M . Public and private dental services in NSW: a geographic information system analysis of access to care for 7 million Australians. N S W Public Health Bull. 2014; 24(4):164-70. DOI: 10.1071/NB13004. View

17.

Rasella D, Aquino R, Barreto M . Reducing childhood mortality from diarrhea and lower respiratory tract infections in Brazil. Pediatrics. 2010; 126(3):e534-40. DOI: 10.1542/peds.2009-3197. View

18.

Lewis M, Eskeland G, Traa-Valerezo X . Primary health care in practice: is it effective?. Health Policy. 2004; 70(3):303-25. DOI: 10.1016/j.healthpol.2004.04.011. View

19.

Williams D, Medina J, Wright D, Jones K, Gallagher J . A review of effective methods of delivery of care: skill-mix and service transfer to primary care settings. Prim Dent Care. 2010; 17(2):53-60. DOI: 10.1308/135576110791013884. View

20.

Listl S . Countries with public dental care coverage have lower social inequalities in the use of dental services than countries without such coverage. J Evid Based Dent Pract. 2015; 15(1):41-2. DOI: 10.1016/j.jebdp.2014.12.001. View