Factors associated with the use of a public information system of dentist-prescribed antibiotics in Minas Gerais, Brazil / Fatores associados ao uso de um sistema de informação público de antibióticos prescritos por cirurgiões-dentistas em Minas Gerais, Brasil

Abstract This article aims to investigate the association between socioeconomic factors, health care organizations, and the use of a management and monitoring system for the dispensing of antibiotics prescribed by dentists in public health services in Minas Gerais, Brazil. This is an ecological-epidemiological study that analyzed secondary data from the Integrated Pharmaceutical Care Management System (SIGAF) of the Department of Health of the state of MG, Brazil, in 2017. Thirteen independent variables were analyzed to assess their influence on municipal adherence to SIGAF system considering dental prescriptions of antibiotics. Descriptive statistical analyses were performed, and the Classification and Regression Tree technique was used to identify the municipal variables associated with the outcome. A total of 57,279 antibiotic courses prescribed by dentists and recorded in SIGAF were examined. Socioeconomic factors were not associated with the use of SIGAF to record these prescriptions. Oral healthcare coverage was positively associated with the use of SIGAF for the dispensing of antibiotics prescribed by dentists. Dental Specialties Center were negatively associated with the outcome. Municipalities with high oral healthcare coverage and those without a Dental Specialties Center were more likely to use SIGAF.

Resumo O objetivo deste artigo é avaliar a associação entre fatores socioeconômicos, organização dos serviços de saúde e a utilização de um sistema de gestão e monitoramento da dispensação de antibióticos prescritos por cirurgiões-dentistas em Minas Gerais, Brasil. Estudo epidemiológico ecológico que analisou dados secundários do Sistema Integrado de Gestão da Assistência Farmacêutica (SIGAF) da Secretaria de Estado de Saúde de MG, Brasil, em 2017. Treze variáveis independentes foram analisadas para testar a influência destas com a adesão dos municípios ao SIGAF das prescrições odontológicas de antibióticos. Foram realizadas análises estatísticas descritivas, e a técnica de Árvore de Classificação e Regressão foi utilizada. Foram examinadas 57.279 prescrições de antibióticos prescritos por dentistas e registradas no SIGAF. Fatores socioeconômicos não foram associados ao uso do SIGAF para registro dessas prescrições. A cobertura de saúde bucal esteve positivamente associada à utilização do SIGAF para as dispensações de antibióticos prescritos por cirurgiões-dentistas. A presença de Centro De Especialidade Odontológica, esteve negativamente associado ao desfecho. Municípios com maior cobertura de saúde bucal e sem Centro de Especialidade Odontológica foram mais propensos a utilizar o SIGAF.

What we know about antibiotics prescribed by dentists in a Brazilian southeastern state

Abstract The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

Padrão das prescrições odontológicas de antibióticos dispensados no Sistema Único de Saúde do estado de Minas Gerais / Standard of dental prescriptions for antibiotics dispensed in the systempublic oral health services in the state of Minas Gerais

Antibióticos, juntamente com analgésicos e anti-inflamatórios, são os medicamentos mais utilizados em odontologia. A prescrição de antibióticos por cirurgiões-dentistas acontece em todo o mundo, sendo que o uso adequado desses medicamentos pode resultar em falha terapêutica, aumento do risco de reações adversas e impacto econômico, além de ser a principal causa de resistência antimicrobiana. A literatura aponta que dor de origem dental raramente é causada por uma infecção bacteriana que requer medicação antibiótica e geralmente é melhor gerenciada com o uso de analgésicos e procedimentos odontológicos locais. Os resultados de pesquisas realizadas na Inglaterra e Canadá sugerem que as prescrições de antibióticos por cirurgiões-dentistas estão aumentando de forma alarmante. Sabe-se também que o padrão de prescrição de antibióticos pode ser influenciado por fatores clínicos e não clínicos. Nesse sentido, gerar informação sobre o consumo de antibióticos é essencial para que os países adotem medidas para a conscientização da população e profissionais de saúde sobre o uso apropriado desses medicamentos, monitorem o impacto das intervenções e aprimorem o processo de aquisição, prescrição e dispensação desses medicamentos. O objetivo deste estudo foi analisar a possível associação entre prescrições odontológicas de antibióticos no setor público de um estado do sudeste brasileiro, características dos serviços de saúde e características sociais municipais. O desenho do estudo foi do tipo ecológico, o ano analisado foi o de 2017 e os dados foram obtidos do banco de dados do Sistema Integrado de Gerenciamento da Assistência Farmacêutica. A variável desfecho do primeiro artigo dessa Tese de Doutorado foi o número de Doses Diárias Definidas (DDD) por 1.000 habitantes/ano dos municípios. A variável desfecho do segundo artigo foi a adesão dos municípios a um sistema de informação de prescrições odontológicas. O banco de dados foi analisado inicialmente no programa Excel versão 2016 (Microsoft, Seattle, USA) e posteriormente no programa SPSS versão 25.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). A técnica CART (Classification And Regression Tree) foi usada para determinar a influência das características sociais dos municípios (Índice de Desenvolvimento Humano, Índice Gini, proporção de população rural, proporção de famílias beneficiárias do Programa Bolsa Família, tipologia rural/urbana, ser ou não município sede de Centro de Especialidades Odontológicas, sede de Macrorregião e Microrregião de Saúde) e das características dos serviços de saúde bucal (cobertura de saúde bucal na Estratégia Saúde da Família e na Atenção Primária à Saúde, cobertura populacional de primeira consulta odontológica, número de cirurgiões-dentistas e de equipes de saúde bucal por 1000 habitantes e percentual de procedimentos odontológicos individuais preventivos e restauradores). Os antibióticos foram os medicamentos mais prescritos pelos cirurgiões-dentistas do setor público pesquisado, sendo as penicilinas o grupo mais prescrito. A média geral de DDD/1000hab/ano, para os 421 municípios pesquisados, foi de 96,54. Fatores de organização de serviços estiveram associados à aceitabilidade dos municípios ao sistema de vigilância analisado.Concluiu-se que fatores socioeconômicos e de organização dos serviços de saúde estiveram associados à utilização de antibióticos. Há necessidade de avanços na vigilância da prescrição de antibióticos nos serviços públicos de saúde bucal do estado de Minas Gerais.

Antibiotics, along with analgesics and anti-inflammatory drugs, are the most commonly used medications in dentistry. The prescription of antibiotics by dental surgeons happens all over the world, and the irrational use of these drugs can result in therapeutic failure, increased risk of adverse reactions and economic impact, besides being the main cause of antimicrobial resistance. The literature points out that pain of dental origin is rarely caused by a bacterial infection requiring antibiotic medication and is usually best managed with the use of analgesics and local dental procedures. The results of surveys conducted in England and Canada suggest that antibiotic prescriptions by dental surgeons are increasing alarmingly. It is also known that the pattern of antibiotic prescribing can be influenced by both clinical and nonclinical factors. In this sense, generating information on antibiotic consumption is essential for countries to adopt measures to raise awareness among the population and health professionals about the appropriate use of these drugs, monitor the impact of interventions, and improve the process of acquiring, prescribing, and dispensing these drugs. The aim of this study was to analyze the possible association between dental antibiotic prescriptions in the public sector of a southeastern Brazilian state, health services characteristics, and municipal social characteristics. The study design was of the ecological type, the year analyzed was 2017, and the data were obtained from the database of the Integrated Pharmaceutical Assistance Management System. The outcome variable of the first article of this PhD Thesis was the number of Defined Daily Doses (DDD) per 1,000 inhabitants/year of the municipalities. The outcome variable of the second article was the municipalities' adherence to a dental prescription information system. The database was analyzed initially in Excel version 2016 program (Microsoft, Seattle, USA) and later in SPSS version 25.0 program (IBM SPSS Statistics for Windows, Armonk, NY, USA). The CART (Classification And Regression Tree) technique was used to determine the influence of the social characteristics of the municipalities (Human Development Index, Gini Index, proportion of rural population, proportion of beneficiary families of the Bolsa Família Program, rural/urban typology, whether or not the municipality is the headquarters of a Dental Specialties Center, seat of a Health Macro-region and Microregion) and the characteristics of oral health services (oral health coverage in the Family Health Strategy and Primary Health Care, population coverage of first dental consultation, number of dentists and oral health teams per 1000 inhabitants, and percentage of individual preventive and restorative dental procedures). Antibiotics were the most prescribed drugs by dental surgeons in the public sector surveyed, with penicillins being the most prescribed group. The overall average of DDD/1000hab/year, for the 421 municipalities surveyed, was 96.54. It was concluded that socioeconomic factors and organization of health services were associated with the use of antibiotics. There is a need for advances in the surveillance of antibiotic prescribing in public oral health services in the state of Minas Gerais.

Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state

Abstract The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

Availability of Analgesic and Anti-Inflammatory Medicines in Primary Health Care

Abstract Objective: To describe and analyze the availability and factors related to the presence of analgesics and non-steroidal anti-inflammatory drugs in the Brazilian public primary healthcare system. Material and Methods: This was a cross-sectional study that evaluated 17,903 health units that participated in the National Program for Primary Care Access and Quality Improvement (2013-2014). The dependent variable was defined as the presence of metamizole, ibuprofen, and acetaminophen in a sufficient amount. The independent variables included the type of primary health care unit, the presence of a medication disposal area, the number of physicians, nurses, and dental practitioners; and the number of primary care units with family and oral health teams. For statistical analysis, unadjusted and adjusted Odds Ratio (OR) (95% CI) were presented. Results: The three medicines were available in 62.4% of the units. Regarding Health Clinics, the Basic Health Units (OR= 1.31, CI95% 1.18-1.44), Polyclinic (OR= 2.00, 95% CI, 1.15 -3.48), and others (OR= 1.37; 95% CI 1.14-1.63) had higher chances of availability of all three drugs. The presence of a disposal area (OR = 1.64, 95% CI 1.51-1.77) and the number of physicians (OR= 1.04, 95% CI 1.00-1.08), nurses (OR= 1.08, 95% CI 1.03- 1.13), and dental practitioners (OR= 1.09, 95% CI 1.04-1.14) increased the availability odds of the analyzed drugs in the service. Conclusion: The structure of the healthcare units and the higher number of professionals were positively associated with the availability of these drugs.

Projeto SB Minas Gerais 2012: Pesquisa das Condições de Saúde Bucal da População Mineira ­ Métodos e Resultados Principais / 2012 SB Minas Gerais Project: main results of an oral health survey in the state of Minas Gerais, Brazil ­ Methods and Main Results

Objetivo: O presente estudo teve como objetivo principal descrever os aspectos metodológicos do Projeto SB Minas Gerais e os resultados principais sobre problemas bucais da população do estado de Minas Gerais.Métodos: Trata-se de um inquérito epidemiológico de saúde bucal realizado no ano de 2012 com representatividade estadual cuja amostra foi realizada por conglomerados e com múltiplos estágios de sorteio. Capital e municípios do interior de Minas Gerais compõem os três domínios da amostra. Avaliou-se a situação da população mineira em relação à cárie, condição periodontal, necessidades de próteses, condições da oclusão e ocorrência de dor de dente, dentre outros aspectos nas idades de 5 e 12 anos e nas faixas etárias de 15-19, 35-44 e 65-74 anos.Resultados: Em relação à cárie, a média ceo/CPO-D para o estado foi de 2,1 na idade de 5 anos, 1,8 aos 12 anos, 3,9 nos adolescentes, 15,9 em adultos e 28,7 nos idosos. Os problemas periodontais aumentam com a idade, sendo 1,60 vezes maior o número de adultos acometidos em relação ao número de adolescentes. Em relação às oclusopatias, aos 5 anos, 54,7% possuíam pelo menos um dos problemas avaliados. O percentual de crianças aos 12 anos e de adolescentes que apresentaram algum tipo de oclusopatia foi de 33,8% e 26,7%, respectivamente. Em relação à prótese dentária, a faixa etária de 65-74 anos foi a que apresentou maior percentual de indivíduos com necessidade de prótese total nos dois maxilares.Conclusão: Associando os indicadores de saúde bucal avaliados às variáveis socioeconômicas, os resultados apontam para importantes desigualdades regionais que devem ser levadas em consideração para elaboração das estratégias de planejamento e avaliação.

Objective: The main objective of this study was to describe the methodological aspects of the SB Minas Gerais Project and the main impacts upon oral health problems in the population of the state of Minas Gerais. Materials and methods: This is an oral health epidemiological survey conducted in 2012, with state representativeness, whose sample was conducted using conglomerates and multiple stages of sampling. The capital city and municipalities in the countryside of Minas Gerais make up the three domains of the sample. The situation of the population of Minas Gerais was evaluated in relation to caries, periodontal condition, prosthesis needs, occlusion conditions, and occurrence of tooth pain, among other aspects, at 5 and 12 years of age and in the age groups of 15-19, 35-44, and 65-74 years. Results: In relation to caries, the mean ceo /CPO-D for the state was 2.1 at 5 years of age, 1.8 at 12 years of age, 3.9 in adolescents, 15.9 in adults, and 28.7 in the elderly. Periodontal problems increase with age, with 1.60 times the number of adults affected in relation to the number of adolescents. Regarding the occlusion problems, at 5 years of age, 54.7% had at least one of the problems evaluated in this study. The percentage of children at 12 years of age and adolescents who presented some type of occlusion problems was 33.8% and 26.7%, respectively. Regarding dental prosthesis, the range of 65-74 years of age presented the highest percentage of individuals with a need for total prosthesis in both jaws. Conclusion: Minas Gerais presents a more favorable profile of oral diseases and, in some situations, is similar to the Southeast region and Brazil as a whole. Associating the oral health indicators evaluated with socioeconomic variables, the results point to important regional inequalities that must be taken into account in the drafting of planning and evaluation strategies.

Hospital Dental Treatment for Special Health Care Needs Patients in Minas Gerais state, Brazil: A Cluster Analysis

Objective: To describe and group some demographic and healthcare characteristics of hospital dental care for the special health care needs population. Material and Methods: Cross-sectional census survey with a total of 1,063 visits with special health care need patients under general anesthesia or sedation at the Brazilian Health System Minas Gerais, Brazil, over 12 months. Clinical diagnosis was divided into "mental and behavioral disorders and diseases of the nervous system" and "others". Age group, gender, clinical diagnosis and care by a general dentist were submitted to descriptive and multivariate cluster analysis. The analysis was performed using the software SPSS version 19.0. Results: Cluster 1 (N=173) had no ICD codes for nervous system (NS) diseases and mental and behavioral disorders. Clusters 2 (N=564) and 3 (N=326) are quite similar except for gender distribution. Cluster 1 was 3.5 times more frequent among non-host cities than HER host cities. Dental treatment was mostly performed on males diagnosed with mental and behavioral disorders and diseases of the NS who were over the age of 25 years and were seen by general dentists. The clusters were distributed unevenly between EHR host and non-host cities. Conclusion: Non-host performed more frequently treatment for patients with no mental and behavioral disorders and diseases of the NS than EHR host cities.

Utilização dos serviços de atendimento odontológico hospitalar sob sedação e/ou anestesia geral por pessoas com necessidades especiais no SUS-MG, Brasil / Availability of hospital dental care services under sedation or general anesthesia for individuals with special needs in the Unified Health System for the State of Minas Gerais (SUS-MG), Brazil

O presente estudo identificou as características demográficas dos indivíduos e assistenciais do tratamento odontológico sob sedação e/ou anestesia geral em ambiente hospitalar no SUS-MG. Foram avaliadas todas as Autorizações de Internações Hospitalares (AIH) para o procedimento Tratamento Odontológico para Pacientes com Necessidades Especiais, de julho de 2011 a junho de 2012. Foram mensuradas variáveis demográficas e assistenciais dos atendimentos. Foram calculadas as taxas de internações por 10.000 habitantes e a cobertura assistencial realizada no estado de Minas Gerais e em cada uma das Regiões Ampliadas de Saúde. A análise descritiva das variáveis foi feita por meio de cálculo da frequência e medidas de tendência central e variabilidade. Foram avaliadas todas as 1.063 AIH pagas no período estudado, que representaram uma taxa de 0,54 internações por 10.000 habitantes. A maioria dos indivíduos era adulta, do sexo masculino, com diagnóstico de transtornos mentais ou comportamentais e residente em 27,7% dos municípios de Minas Gerais. Os procedimentos foram realizados em 39 municípios e a cobertura assistencial foi igual a 1,58%. O estudo revelou um perfil clássico do paciente atendido. Dificuldades em se estabelecer uma rede de atenção à saúde bucal foram identificadas.

This study identified the demographic characteristics of individuals and dental treatment care under sedation/general anesthesia in a hospital environment in the Unified Health System in the State of Minas Gerais (SUS-MG). All Hospitalization Authorizations (AIHs) for Dental Treatment for Patients with Special Needs procedures were evaluated between July 2011 and June 2012. Demographic and health care variables for treatment were also assessed. Hospitalization rates per 10,000 inhabitants, and health care coverage provided in the state of Minas Gerais and in each of the Broader Health Regions were calculated. Descriptive analysis of data was carried out by calculating the central trend and variability frequency and measurements. All 1,063 AIHs paid during the study period were evaluated, which is equivalent to a rate of 0.54 hospitalizations per 10,000 individuals. The majority of the patients were adult, male, diagnosed with mental or behavioral disorders and resident in 27.7% of the municipalities in Minas Gerais. The procedures were performed in 39 municipalities and the care coverage was equal to 1.58%. The study reveals a classic demographic and clinical profile of patient attendance. Difficulties in establishing a network of dental care were identified.

O tratamento odontológico hospitalar para pacientes com necessidades especiais no Sistema Único de Saúde do Estado de Minas Gerais / Hospital dental treatment for patients with special needs in the Unified Health System of the State of Minas Gerais

Este trabalho tem como fio condutor a interface entre pessoas com deficiência e pessoas com necessidades especiais para fins da assistência odontológica. Foi realizado com o objetivo de conhecer o perfil dos serviços que realizaram o tratamento odontológico sob sedação ou anestesia geral, assim como o das pessoas que foram atendidas, no SUS de Minas Gerais durante o período de julho/2011 a junho/2012. Caracteriza-se como um estudo censitário, descritivo e exploratório...