Análise da assistência odontológica prestada à pessoa com deficiência na Atenção Primária à Saúde, sob a perspectiva de cirurgiões-dentistas

Abstract

People with disabilities (PcD) are part of a group of people who can suffer from major oral complications, so the oral health team (eSB) plays a fundamental role in the logic of comprehensiveness and humanization when it comes to dental care for this population. The eSB needs to provide care to these users, welcoming them, taking anamneses, attending to their complaints, requesting complementary tests, monitoring the progress of each case and, when necessary, making referrals to other levels of the healthcare network. However, many professionals are still insecure and unable to deal with the complexity of a PcD. With this in mind, this dissertation aimed to analyze the dental care provided to PcD in Primary Health Care (APS), in a medium-sized municipality in the north of Minas Gerais - Brazil, from the perspective of dental surgeons. This is an observational, cross-sectional and analytical epidemiological study. The target population consisted of 145 dental surgeons working in the municipality's APS. A semi-structured questionnaire was used which covered sociodemographic and economic characteristics, occupational profile and academic training, with questions prepared by the researchers. Dental care for the PcD was investigated using questions based on previous studies (independent variables) and the outcome variable "Coordination attribute - integration of care" was assessed using block C of the validated Pcatool instrument, version for professional dental surgeons. To interpret the data, absolute distributions and univariate and bivariate descriptive analyses were obtained, as well as statistical measures: mean, standard deviation, coefficient of variation, minimum value and maximum value (descriptive statistics techniques) and Pearson's chi-square test or Fisher's exact test (analytical methods). The significance level adopted was 5.0%. The results showed that the dentists investigated provided care for the PcD, their reception was considered to be very good, they carried out home visits and developed relationships of bonding and accountability with the PcD. They also carried out clinical examinations and dental treatment when possible and, when necessary, made referrals to another level of health care. It was found that dentists who had worked in APS for up to five years rated the quality of their team's reception better than those who had worked there for longer. This same group also saw the need to better train the eSB to care for the PcD. As for the coordination of care for the PcD, the attribute coordination/integration of care in APS in this study showed a low score, demonstrating an unsatisfactory evaluation of the attribute investigated. It was observed that the eSBs with the attribute of coordination/integration of care in APS considered satisfactory had a significant association with the best evaluations of the resolutive services of the Dental Specialties Center (CEO) for the care of the PcD (p=0.047), with the evaluation of the counter-referral of the CEO care carried out with the PcD (p=0.026), with knowledge of the clinical referral of the PcD for care at the hospital level (p=0.014), with the perception of the resolutiveness of the hospital level for care of the PcD (p=0.011), with knowledge of the current referral flow of the PcD for care at the hospital level (p=0.040) and with the evaluation of the counter-referral of care at the hospital level, carried out with the PcD (p=0.008). It can be concluded that most of the dentists interviewed in this study reported providing dental care to the PcD, but among those professionals with less time working in APS, there was a better assessment of the quality of the reception provided by the eSB and a perception of the need to better train the team to provide care to the PcD, when compared to those with more time working in APS. As for the coordination/integration of care in APS, there were weaknesses in the service offered by the eSB to the PcD, but the dentists claim to provide dental care in APS and consider that they have good coordination and communication with the other levels of oral health care for the PcD. It is hoped that this data can support public strategies to help managers improve dental care for the PwD in the Unified Health System (SUS), thus considering the reorganization of the network.