ABSTRACT
Resumo A atenção secundária em odontologia no Brasil apresenta recursos escassos e em grande parte subutilizados. O desafio consiste em realizar a interface entre a atenção primária à saúde (APS) e a atenção secundária de forma a consolidar o acesso da população à atenção odontológica especializada no Sistema Único de Saúde (SUS). O objetivo deste artigo é analisar publicações nacionais em língua portuguesa e inglesa sobre a interface entre a atenção secundária e a APS em odontologia na perspectiva da integralidade do cuidado no âmbito do SUS. Revisão integrativa considerando as publicações dos seguintes bancos de dados: SciELO (Scientific Eletronic Library Online), Lilacs (Literatura Latino-Americana e do Caribe), Web of Science, Scopus, PubMed (Literatura Internacional em Ciências da Saúde) e Google Acadêmico. Foram encontrados 966 artigos, dos quais 12 foram utilizados na integra. A cobertura das equipes de saúde bucal (ESB) nas estratégias de saúde da família (ESF), a implantação da APS de forma estruturada, o acesso a atenção secundária, o contrarreferenciamento para APS, os indicadores de desenvolvimento e as condições socioeconômicas e desigualdades na distribuição dos CEO's são fatores que influenciam a integralidade do cuidado em saúde bucal no SUS.
Abstract Secondary care in dentistry in Brazil has scarce and broadly underutilized resources. The challenge is to organize the interface between primary health care (PHC) and secondary care in order to consolidate the population's access to specialist dental care in the Unified Health System (SUS). This article seeks to analyze national publications in Portuguese and English on the interface between secondary health care and primary health care in dentistry from the perspective of comprehensive care in the SUS. It is an integrative review, considering the publications of the following databases: SciELO (Scientific Electronic Library Online), LILACS (Latin American and Caribbean Literature) WEB OF SCIENCE, SCOPUS, PubMed (International Literature on Health Sciences) and GOOGLE SCHOLAR. The search located 966 articles, of which 12 were used in full. Coverage of the oral health teams (ESB) in the family health strategy (ESF), primary health care implementation in a structured way, access to secondary health care, counter-referral to PHC, development of indicators and socioeconomic conditions and inequalities in the distribution of dental specialist centers (CEO) are factors that influence the integrity of oral health care in the SUS.
Subject(s)
Humans , Primary Health Care/organization & administration , Secondary Care/organization & administration , Dental Health Services/organization & administration , Patient Care Team/organization & administration , Primary Health Care/economics , Socioeconomic Factors , Secondary Care/economics , Brazil , Dental Care/economics , Dental Care/organization & administration , Dental Health Services/economics , Health Services Accessibility , National Health Programs/economics , National Health Programs/organization & administrationABSTRACT
El trabajo enfoca el costo en salud, y particularmente su crecimiento, bajo una óptica gerencial, lo que implica destacar aquellos aspectos que se relacionan con los recursos empleados y la efectividad en los resultados para la salud de las personas y las poblaciones. Se presentan cinco posibles causas que pudieran explicar la multicausalidad del crecimiento de los costos en salud. Tres de ellas tienen la particularidad de que no aparecen suficientemente analizadas en estudios sobre el tema de los costos en salud y todas tienen un componente gerencial significativo: la corrupción, la deficiente organización de los servicios y el manejo irresponsable de los recursos por parte de los prestadores. Se amplía el análisis de la última causa mencionada al considerar que tiene mayor interés gerencial, ya que acumula un porcentaje alto de los costos y al mismo tiempo, es un elemento susceptible de modificarse por los gerentes en los niveles de atención primaria y secundaria. Para ampliar las posibilidades del análisis se procede a tratar la causa como problema y a este se le aplica el diagrama de causa-efecto de Ishikawa, que permite revelar las subcausas sobre las cuales los gerentes pudieran enfocar su trabajo para convertir la irresponsabilidad en corresponsabilidad. En la parte final se analizan cada una de las subcausas y se hacen recomendaciones sobre los métodos, habilidades y tecnologías gerenciales útiles para producir el cambio
This paper focused on health costs, particularly their increase, from a management approach. This implied to underline those aspects associated with the resources used and the effectiveness of results for the health of individuals and populations. Five possible causes that might explain the multi-causality of the health cost increases were presented. Three of them had not been deeply analyzed in the studies on health costs and had a basic management component: corruption, poor organization of service and irresponsible management of resources on the part of providers. The analysis of the last mentioned cause is extensive since it has a greater management interest, accounts for a high percentage of costs and it is at the same time an element that can be changed at the primary and secondary care levels by the managers. In order to extend the analytical possibilities, the cause was seen as a problem to which Ishikawaïs cause/ effect diagram was applied. This allowed disclosing the subcauses upon which the managers might work to turn irresponsibility into co- responsibility. The last part of the paper analyzed each of these subcauses and made recommendations about the useful management methods, abilities and technologies to bring about the desired changes