Insatisfação com os serviços odontológicos entre usuários brasileiros: estudo multinível

Abstract

The evaluation of users' satisfaction with dental services, among their various concepts, is defined in this thesis as the perception of the quality of oral health care received by users. This concept, which is used in this thesis and in its three respective products, articulates with the theoretical model of Andersen and Davidson in order to be able to measure the perception of the users of different age groups (adolescents, adults and elderly) on the quality of care in their last consultation and the factors that are associated with dissatisfaction with these services. The objective of the study was to evaluate, from multilevel modeling, the contextual and individual factors associated with dissatisfaction with oral health services among the Brazilian population in age cohort of 15-19, 35-44 and 65-74 years. The research is characterized by an analytical cross-sectional study with individual data from the "Project SB Brasil 2010" and contextual data from the 177 cities investigated in SB Brasil obtained from public databases (DATA SUS, IBGE and Atlas Brasil). The theoretical model of Andersen and Davidson adapted was used. Studies were conducted considering the samples of age cohort 15-19 years (n = 5445), 35-44 years (n = 9779) and 65-74 years (n = 7619). The dependent variable studied was "satisfaction with oral health services" obtained from the question "How would you rate your last visit?". The independent variables followed the theoretical model adopted, being organized into groups of variables: context (environment, social/economic condition, health system, care indicators); individual primary determinants (personal characteristics immutable, and changeable); behavior (use of dental services); and outcome (normative/objective oral health condition, subjective oral health condition, satisfaction with oral health services). The dependent variable considered refers to one of the outcomes of the theoretical model adopted. Multilevel logistic regression was conducted, with hierarchical input of the groups of variables. The prevalence of dissatisfaction was 14.1% among teenagers, 14.9% among adults and 14.3% among the elderly. The odds of dissatisfaction in teenager group were higher among those residing in cities with greater inequality measured by the Gini index; who consulted for more than a year; those who consulted for oral health problems; who used another service other than Brazilian public health system; who did not self-perceive the need for treatment; dissatisfied with teeth and mouth; among those with impact of oral disorders on daily performance and those who reported toothache. Among adults, the odds of dissatisfaction were higher among those who lived in cities with greater social inequality and with a proportion of dentists lower than the national average; among those who declared themselves yellow/ black/brown/indigenous; those with less schooling; those who consulted on the grounds of oral problems; those who were dissatisfied with teeth and mouth and those who had impacted oral disorders in daily performance. Among the elderly, dissatisfaction was lower among those living in cities with a very low/low/medium human development index; and higher among those who lived in cities with greater social inequality; with a lower proportion of dentists per inhabitant; among men; those who consulted for oral health problems; those who reported toothache; those dissatisfied with teeth and mouth and between those with impact of oral disorders on daily performance. This study revealed contextual and individual characteristics that should be taken into account in the adequacy of existing public health policies, as well as being a guideline in the creation of new ones, in view of the points raised in order to meet the need and actual demand of the user the dental service.