Avaliação da atenção secundária em endodontia em um Centro de Especialidades Odontológicas (CEO) / Evaluation of secondary care in endodontics at a Dental Specialties Center (DSC)

Resumo Objetivou-se avaliar a atenção secundária em endodontia em um Centro de Especialidades Odontológicas (CEO) de Belo Horizonte (MG). A coleta de dados utilizou dois formulários: (1) sobre o tratamento endodôntico, preenchido pelos endodontistas; (2) sobre o tratamento restaurador, com dados dos prontuários. O programa SPSS 19.0 foi utilizado para analisar os resultados por meio de frequência e percentis. Foram finalizados 452 tratamentos endodônticos em pacientes adultos. Os pacientes apresentaram mediana de 39 anos de idade, a maioria era do sexo feminino (69,7%) e apresentou guia de referência da atenção básica (96,2%). A maior parte dos tratamentos endodônticos foi realizada em pré-molares superiores (23,7%), seguida de molares inferiores (22,3%), utilizando técnica mista (74,1%) e em única sessão (64,2%). O encaminhamento para o tratamento restaurador foi para o CEO em 81,2% dos casos e finalizado em 24,1% casos (n = 109). A contrarreferência após o tratamento restaurador ocorreu em 58,7% dos casos finalizados. É necessário um planejamento conjunto do tratamento odontológico entre a atenção básica e secundária e, dentro desta última, entre as especialidades, além de um adequado processo de referência e contrarreferência, visando garantir a integralidade do cuidado e a eficiência e eficácia do serviço.

Abstract This study aimed to evaluate secondary endodontic care at a Dental Specialties Center (DSC) in Belo Horizonte, MG. Data collection used two forms: (1) on endodontic treatment, completed by the endodontists (2) on the restorative treatment, with data from the medical records. The SPSS 22.0 program was used to analyze the results using frequency and percentiles. In total, 452 endodontic procedures were completed in adult patients. The patients had a median of 39 years of age, most were female (69.7%) and had a primary care referral order (96.2%). Most endodontic treatments were performed in upper premolars (23.7%) followed by lower molars (22.3%), using a mixed technique (74.1%) and in a single session (64.2%). The referral for restorative treatment was for the DSC in 81.2% of cases and finished in 24.1% (n = 109). The counter-referral following restorative treatment occurred in 58.7% of the completed cases. It is necessary to jointly plan the dental treatment between primary and secondary care and, within the latter, among the specialties, in addition to an adequate referral and counter-referral process aimed at ensuring comprehensive care and efficient and effective service.

Factores de riesgo para intento de suicidio en personas con trastorno depresivo en atención secundaria / Risk factors for suicide attempts in people with depressive disorders treated in secondary health care

Background: Depression is the most common psychiatric disorder in people with suicidal behavior. The knowledge of its risk factors should help to design preventive strategies. Aim: To describe suicidal behavior and risk factors for attempted suicide in people with major depressive disorders (MDD). Material and Methods: A 12-month follow-up study was conducted in 112 outpatients at three psychiatric care centers of Ñuble, Chile, with baseline and quarterly assessments. Demographic, psychosocial and clinical factors as potential risk factors of suicide attempts, were assessed. A clinical interview with DSM-IV diagnostic criteria checklist, Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results: Sixty seven percent of participants had suicidal ideation and 43.8% had attempted suicide. Suicide risk was significantly higher in participants with a single major depressive episode (odds ratio [OR] = 3.98; 95% confidence intervals [CI] = 1,29-12,32 p = 0.02) and those with previous suicide attempts (OR = 13.15; 95% CI = 3,87-44.7 p < 0.01). Young age, not having a partner, being unemployed, having a severe major depressive episode, having psychotic symptoms, having a personality disorder and being devoid of medical illness increased the risk of suicide attempts, but they did not reach statistical significance. Conclusions: Significant risk factors should be specially considered when designing suicide preventive strategies in patients with MDD.

Health Care Network: Maternal perception regarding the quality of care to children with microcephaly / Red de Atención a la Salud: Percepción materna en cuanto a la calidad de atención de niños con microcefalia / Rede de Atenção à Saúde: Percepção materna quanto à qualidade de atendimento de crianças com microcefalia

Abstract Objective: To identify the perception of primary caregivers on the quality of the Health Care Network of children with microcephaly related to congenital infection. Methods: A cross-sectional study carried out from October 2017 to April 2018. Results: The 105 participants assessed the health of their children as reasonable (56.1%). The level of care which got the highest percentage - 57 (54.3%) - of participants' dissatisfaction was of Primary Health Care (p=0.0216). Most of the specialties of secondary health care services were classified as poor/very poor, regarding the quality of the consultation at the secondary level (p<0.05). For the majority - 61 (58%) - of the mothers, regarding this level of attention, the items waiting time and appointment scheduling were evaluated as excellent/good (p<0.05). Conclusion and implications for practice: There is dissatisfaction among mothers considering the quality of services provided by the health care network for children with microcephaly, mainly in primary care. There was easiness in the access to Secondary Care, and little use of Tertiary Care services. It is urgent to elaborate policies that better disseminate humanization and facilitate the accessibility to multiprofessional care for those children.

Resumen Objetivo: Identificar la percepción de cuidadores principales sobre la calidad de la Red de Atención a la Salud de niños con microcefalia relacionada con infección congénita. Métodos: Investigación de corte transversal realizada entre octubre 2017 y abril de 2018. Resultados: Las 105 participantes evaluaron la salud de sus hijos como razonable (56,1%). El nivel de atención que obtuvo el mayor porcentaje de insatisfacción - 57(54,3%) - fue en la Atención Primaria (p=0,0216). La mayoría de las especialidades de la Atención Secundaria fueron clasificadas como mala/muy mala, sobre la calidad de la consulta en el nivel secundario (p<0,05). Para la mayoría - 61(58%) - de las madres, en cuanto a ese nivel de atención, los ítems tiempo de espera y programación de consulta fueron evaluados como excelente/bueno. Conclusión e implicaciones para la práctica: Hubo insatisfacción de las madres con la calidad de servicios prestados por la Red de Atención a la Salud del niño con microcefalia principalmente en la Atención Primaria. Hubo facilidad de acceso a la Atención Secundaria, y poca utilización de los servicios de la Atención Terciaria. Es urgente la elaboración de políticas que mejor difundan la humanización y faciliten la accesibilidad a la atención multiprofesional para estos niños.

Resumo Objetivo: Identificar a percepção de cuidadores principais sobre a qualidade da Rede de Atenção à Saúde de crianças com microcefalia relacionada à infecção congênita. Métodos: Estudo de corte transversal realizado no período de outubro de 2017 a abril de 2018. Resultados: As 105 participantes avaliaram a saúde de seus filhos como razoável (56,1%). O nível de atenção que obteve o maior percentual - 57(54,3%) - de insatisfação das participantes foi o da Atenção Primária à Saúde (p=0,0216). A maioria das especialidades da Atenção Secundária à Saúde foi classificada como ruim/muito ruim, quanto à qualidade da consulta no nível secundário (p<0,05). Para a maioria - 61(58%) - das mães, quanto a esse nível de atenção, os itens tempo de espera e agendamento de consulta foram avaliados como excelente/bom (p<0,05). Conclusão e implicações para a prática: Existe insatisfação das mães com a qualidade dos serviços prestados pela Rede de Atenção à Saúde da criança com microcefalia, principalmente na Atenção Primária. Houve facilidade no acesso à Atenção Secundária, e pequena utilização dos serviços da Atenção Terciária. É urgente a elaboração de políticas que melhor difundam a humanização e facilitem a acessibilidade ao atendimento multiprofissional para essas crianças.

Implementation of dental specialty centers: a descriptive analysis of the current status in the Brazilian territory

ABSTRACT This study aimed to assess the current implementation status of Dental Specialty Centers (Centros de Especialidades Odontológicas - CEO) in Brazil. The sample included CEOs implemented up to November 2015 in the 27 Brazilian federative units. Data were obtained directly from the database of the Informatics Department of the Brazilian Unified Health System, according to the National Registry of Health Facilities (NRHF) of Dental Specialty Centers of all Brazilian regions. Primary care data were also collected from the cities with implemented CEOs, including coverage status of the Family Health Strategy (FHS) and number of Oral Health Teams (OHT) I and II, at 2 collection periods (January 2006 and November 2015). There were 1019 CEOs implemented in Brazil, which were unequally distributed among the Brazilian states, with prevalence of implementation of CEOs type II (n=503, 49.4%). The statistical analysis showed significant difference between the three types of CEO (I, II, and III) and the variables of coverage rate (FHS) and number of teams (OHT I, OHT II) at both data collection periods. Although presenting an evolutionary aspect in the implementation of CEOs, the implementation of medium-complexity care in Brazil is disorganized.

Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención / Predictors of remission from major depressive disorder in secondary care

Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy.

Detección precoz de pacientes con riesgo de diabetes mellitus en la atención secundaria de salud / Early detection of patients at risk of diabetes mellitus in secondary health care

Introducción: los pacientes prediabéticos poseen riesgo de desarrollo de diabetes mellitus. Su diagnóstico precoz puede prevenir la aparición de esta condición metabólica. Objetivo: identificar la prevalencia de pacientes con prediabetes durante el chequeo médico y la caracterización de algunos aspectos clínicos y epidemiológicos. Métodos: se realizó un estudio observacional, descriptivo y transversal en el Hospital Militar Docente Dr. Mario Muñoz Monroyde Matanzas. La muestra estuvo constituida por 434 individuos a los que se les diagnosticó prediabetes. Resultados: predominó el sexo masculino (88 por ciento), siendo más frecuente para ambos sexos el grupo de edad de 45 a 54 años. En la categoría de glicemia en ayunas alterada hubo 234 pacientes (54 por ciento), 139 (32 por ciento) con tolerancia a la glucosa alterada y 61 (14 por ciento) portadores de prediabetes doble. El factor de riesgo más frecuente fue la dislipidemia, seguido del índice de masa corporal mayor e igual de 25 y la edad mayor de 45 años. En las enfermedades concomitantes predominó la hipertensión arterial esencial (68 por ciento) y la cardiopatía isquémica (25 por ciento). En el estado nutricional predominaron los sobrepesos y obesos con el 54 y 47 por ciento, respectivamente. Conclusiones: en la atención secundaria de salud fue detectada precozmente una elevada prevalencia de pacientes con riesgo de desarrollo de diabetes mellitus tipo 2 que desconocían su condición(AU)

Introduction: Pre-diabetic patients are at risk of developing diabetes mellitus. Early diagnosis can prevent the onset of this metabolic condition. Objective: To identify the prevalence of patients with prediabetes during the medical check-up, and at the same time to characterize some clinical and epidemiological aspects. Methods: An observational, descriptive and cross-sectional study was conducted at the Military Teaching Hospital Dr. Mario Muñoz Monroy from Matanzas. The sample consisted of 434 individuals who were diagnosed with prediabetes. Results: The male sex predominated (88 percent), being more frequent for both sexes the age group of 45 to 54 years. In the altered fasting glycemia category, there were 234 patients (54 percent), 139 (32 percent) with impaired glucose tolerance and 61 (14 percent) patients with double prediabetes. The most frequent risk factor was dyslipidemia, followed by a greater and equal body mass index of 25 and age over 45 years. In the concomitant diseases, essential hypertension predominated (68 percent) and ischemic heart disease (25 percent). In the nutritional status, overweight and obese were predominant with 54 and 47 percent, respectively. Conclusions: At secondary health care, a high prevalence of patients with risk of developing type 2 diabetes mellitus who did not know their condition was detected early(AU)

Avaliação dos serviços públicos de Endodontia nos Centros de Especialidades Odontológicas de Minas Gerais / Assessment of public services in Endodontics in Dental Specialties Centers of Minas Gerais, Brazil

Objetivo do estudo foi avaliar serviços de Endodontia na atenção secundária dos Centros de Especialidades Odontológicas (CEO) de Minas Gerais (MG), em 2014. Dados de produtividade foram extraídos do TABWIN, segundo Cadastro Nacional de Estabelecimento de Saúde dos CEO/MG. Variáveis de caracterização dos municípios (porte populacional, IDH, Índice de Gini), e dos serviços (cobertura PSF, tempo de credenciamento, tipo de CEO, produtividade) foram extraídas do IBGE e DATASUS. Avaliação dos gestores de saúde bucal dos municípios foi feita por um questionário. Análise descritiva e Correlação de Spearman foram realizadas a um nível significância de 5%. Distribuídos por 70 municípios, 76 CEO credenciados compuseram amostra, dos quais 65,8% eram tipo II. Tempo mediano de credenciamento foi 8 anos. A maioria das cidades apresentou porte populacional <50 mil habitantes (39,4%), IDH e Índice de Gini com 52,6% e 65,8%, respectivamente, acima da mediana e 93,4% das cidades com cobertura de PSF ≥ 50%. Endodontia de dentes unirradiculares apresentou maior mediana de produção, seguidos pelos trirradiculares e birradiculares, mas a maioria dos CEO não atingiu metas de produtividades estabelecidas pelo Ministério da Saúde (MS) e 52,63% alcançaram metas em menos de 25% dos meses disponíveis para análise. Houve correlação positiva, respectivamente, entre total de procedimentos de endodontia e média mensal de produtividade e porte populacional (p = 0,006; p = 0,003) e tipo de CEO (p= 0,004; p = 0,001); além de porcentagem de meses com meta alcançada e porte populacional (p = 0,015) e número de meses com meta alcançada e número de meses disponíveis para análise de produção (p=0,011). Houve retorno de 94,29% dos questionários dos gestores, a maioria era dentista (89,4%) e estava há mais de 2 anos no cargo (53%). A maioria das cidades tinha apenas um CEO em funcionamento (92,4%) com 2 dentistas (30,3%). Em 87,9% das cidades, endodontia era realizada apenas no CEO. Assistência em endodontia a outros municípios foi observada em 69,7% dos CEO, sendo 59,1% municípios da mesma microrregião de saúde. Haviam protocolos de referenciamento da atenção primária para CEO em 87,9% da amostra e, destes, 37,9% tinham protocolo municipal próprio e 34,8% seguiam o do MS. A maioria dos CEO tinha lista de prioridades no atendimento (65,2%) e 84,8% tinham meta de produtividade a seguir, sendo que 60,6% destes seguiam metas do MS. Em 50% dos CEO, tempo de espera para início da endodontia foi 1-6 meses. A maioria dos CEO não tinha recursos tecnológicos (42%) para endodontia e, após conclusão desta, 50% dos pacientes eram contra referenciados à atenção primária. Houve uma correlação positiva entre o número de dentistas que realizaram tratamento endodôntico no CEO com o total de procedimentos endodônticos (p=0,0013) e porcentagem de meses com meta alcançada (p=0,029); e correlação negativa entre recursos tecnológicos disponíveis com total de procedimentos endodônticos (p=0,010) e porcentagem de meses com meta alcançada (p=0,012). A maioria dos serviços de Endodontia nos CEO avaliados não alcançaram as metas. Observou-se que gestores desconhe

Aim of this study was to evaluate Endodontics services in secondary care of the Dental Specialties Centers (DSC) of Minas Gerais (MG), during 2014. Outputs were collected from TABWIN, according to National Register of Health Establishment of the DSC of MG. Variables of municipalities characterization (population size, Human Development Index (HDI), Gini Index) and services (Family Health Program (FHP) coverage, accreditation, type of DSC, output) were extracted from the IBGE and DATASUS. Assessment of oral health managers of municipalities was done through a questionnaire. Descriptive analysis and Spearman correlation were performed, considering 5% significance level. Spread over 70 cities, 76 accredited DSC composed the sample, of which 65.8% were type II. Accreditation median time of DSC was 8 years. Most cities showed population size less than 50 thousand inhabitants (39.4%), HDI and Gini Index with 52.6% e 65.8%, respectively, above the median and 93.4% of the cities with FHP coverage above 50%. Single-rooted teeth' endodontics showed the highest median production, followed by multi- and birradiculars teeth. Most DSC did not reach output target established by the Brazilian Ministry of Health (MofH) and 52.63% achieved targets in less than 25% of available months for analysis. There was a positive correlation, respectively, between a total of endodontic procedures and monthly mean of productivity and population size (p = 0.006; p = 0.003) and DSC type (p = 0.004; p = 0.001); besides of percentage of months with targets reached and population size (p = 0.015); and number of months with achieved target and number of available months for production analysis (p = 0.011). There was return of 94.29% of the managers' questionnaires, most had graduated in Dentistry (89.4%) and were more than two years in post (53%). Most cities had only one operating DSC (92.4%) with two dentists (30.3%). Endodontic treatments were performed exclusively in DSC (87.9%), and in 69.7% of DSC there was demand for endodontics assistance from other municipalities, being 59.1% from the same health microregion. There were referencing protocols from primary to secondary care in 87.9% of DSC, where 37.9% followed their own municipal protocol and 34.8% the MofH protocol. Most DSC had priorities list in attendance (65.2%) and 84.8% had one following output target, and 60.6% of these followed goals of MofH. In 50% of DSC, waiting time for start of endodontics was 1-6 months. Most DSC did not have technological resources (42%) to endodontic treatments and, after conclusion of endodontic treatment, 50% of patients were counter-referred to primary care. There was positive correlation between number of dentists that performed endodontic treatments in the DSC with total endodontics procedures (p = 0.013) and percentage of months with target reached (p = 0.029); and negative correlation between available technological resources with total endodontics procedures (p = 0.010) and percentage of months with target reached (p = 0.012). Most endodontics services in evaluated DSC did not achieve targets. It noted that some managers unaware principles of the MofH, demanding that management measures and targets must be reevaluated

Caracterización epidemiológica de atenciones en un servicio de atención primaria de urgencias de la región metropolitana, Chile 2015 / Epidemiological characterization of attention in a primary attention and emergency service of the metropolitan region, Chile 2015

Introducción: Los Servicios de Atención Primaria de Urgencia (SAPU) juegan un rol clave en la atención en salud. Existe escasa caracterización de la población consultante de estos centros. Objetivo: Caracterización clínica y epidemiológica de las atenciones de urgencia del SAPU adosado al centro de salud familiar Garín durante el año 2015. Materiales y método: Estudio descriptivo de corte transversal. Información obtenida de tablas digitales de Datos de Atención de Usuarios durante el período enero ­ diciembre 2015. Se analizaron las variables: edad, sexo, previsión, causa de derivación y lugar de destino así como también grupos diagnósticos generales clasificando cada consulta. Resultados: El número total de pacientes fue 51.630. La edad promedio fue 34,3 años y el 61,8% pertenecía al grupo de 15 ­ 65 años. El 58% fueron mujeres. El 4,1% de la población estudiada fue derivada. Se derivan al mes en promedio 5,9 casos por Accidente Cerebro Vascular (ACV) y 7,8 por Síndrome Coronario Agudo (SCA). Las consultas más frecuentes fueron por causa respiratoria (31,3%) y gastrointestinales (17,7%). Discusión: Las características predominantes de la población son concordantes con estudios nacionales e internacionales en donde las consultas de urgencia, la mayoría corresponden a mujeres alrededor de 35 años. Un pequeño porcentaje de la población consultante es derivada a atención secundaria. Sugerimos continuar el énfasis en las enfermedades cardiovasculares (ACV y SCA) porque a pesar de no concentrar un gran número de derivación, sí cobran relevancia dado su alta morbi-mortalidad. El conocimiento de las características de la población es vital para optimizar las estrategias en la atención de salud.

Introduction: Primary Attention Emergency Services (PAES) play a crucial role in the Chilean health system. The characteristics of the population which uses these services are relatively unknown. Objetive: Clinical and epidemiological characterization of emergency care of PAES attached to the family health center Garín during the year 2015. Materials and methods: Descriptive, cross-section, retrospective study. Information obtained from digital user data for the period January-December 2015. The variables analyzed were age, sex, health insurance, cause and location of patient referral, as well as the general diagnostic groupings which classify each consultation. Results: The total number of patients was 51,631 and 58% were women. The average age was 34.3 years, and 61.8% belonged to the 15-65 years age group. A total of 4.1% of patients were referred to other centers. A monthly average of 5.9 cases is referred because of stroke and 7.8 cases for acute coronary syndrome (ACS). The most frequent consultations were due to respiratory (31.3%) and gastrointestinal (17.7%) causes. Discussion: The predominant characteristics of the reviewed patient population are consistent with national and international studies which show that most emergency consultations are made by women about 35 years old. A small percentage of patients is referred to secondary medical care. We suggest continuing the focus on cardiovascular diseases (stroke and ACS) becauses, although they do not represent a large number of referrals, they are significant because of their high rate of morbidity and mortality. Knowledge about the characteristics of the patient population is vital for optimizing health-care strategies.

Análise da atenção secundária em saúde bucal no estado de Minas Gerais, Brasil / Analysis of secondary care in oral health in the state of Minas Gerais, Brazil

Este estudo descreveu e analisou os procedimentos especializados ambulatoriais nas áreas de periodontia, endodontia e cirurgia bucal em Minas Gerais, 2010. Utilizou-se dados secundários dos procedimentos realizados nos estabelecimentos de saúde e registrados no Sistema de Informação do Sistema Único de Saúde. A análise descritiva e bivariada foi realizada, considerando p < 0,05. Foram executados 707.559 procedimentos em 2.547 unidades de saúde distribuídas em 693 (81%) municípios. Destes procedimentos, 55% são da área de cirurgia, 28% da periodontia e 17% são da endodontia. As unidades são predominante públicas, sob administração municipal, 52,5% possuem alguma equipe de saúde bucal (ESB), 96,9% não tem habilitação como Centros de Especialidades Odontológicas (CEO). Os CEO são mais eficientes que as demais unidades (p < 0,001), mas há importante percentual que não cumpre as metas do Ministério da Saúde. Os municípios com CEO possuem maior população, mais ESB, menor cobertura potencial por estas e melhores IDH. Um significativo número de procedimentos especializados é realizado, especialmente em estabelecimentos de atenção básica. CEO são mais eficientes do que os não CEO, considerandose a média de procedimentos realizados. As metas de produção mínima são cumpridas por uma minoria de CEO.

The scope of this study was to describe and analyze specialized outpatient procedures in periodontics, endodontics and oral surgery performed in the State of Minas Gerais in 2010. Secondary data for the procedures performed in healthcare facilities and registered in the Information System of the Unified Health System were used. Descriptive and bivariate analysis was performed, considering p <0.05. 707,559 procedures were performed in 2,547 health units distributed in 693 (81%) counties in the State. Of these procedures, 55% are in the area of surgery, 28% in periodontics and 17% in endodontics. The units are predominantly public under municipal administration, 52.5% of which have an oral health team (OHT) and 96.9% have no qualification as Dental Specialty Centers (DSCs). DSCs are more efficient than the other units (p <0.001), but there is a significant percentage that fails to comply with the goals of the Ministry of Health. Municipalities that have DSCs have higher population, more OHTs, lower potential coverage and better HDI. A significant number of specialized procedures are performed in the State of Minas Gerais, especially in primary care settings. DSC establishments are more efficient than non-DSC, considering the average number of procedures. The minimum production goals are met by a minority of DSCs.

Avaliação da atenção secundária em saúde bucal: uma investigação nos centros de especialidades do Brasil / Evaluation of secondary care in oral health: a study of specialty clinics in Brazil

Este trabalho discorre a respeito da avaliação da atenção secundária no âmbito da vigilância em saúde. Estudo descritivo, de caráter avaliativo normativo. Para análise de desempenho, foram utilizados dados secundários, com base na série histórica da produção de procedimentos odontológicos realizados nos CEO implantados no país e registrados pelo SIA/SUS no ano de 2007, e dados primários, pela visita in loco de 10% dos serviços implantados, com uso de questionários dirigidos à equipe profissional do CEO. Dentre os CEO analisados, observou-se que na maioria das regiões houve dificuldade no cumprimento das metas relativas à quantidade de procedimentos a serem informados no SIA/SUS. Sendo a Região Norte com menor percentual de serviços implantados. O indicador Cumprimento da Atenção Secundária em Saúde Bucal foi de 64,4%. Os CEO tipo III tiveram melhores resultados para o desempenho e cumprimento das metas. Foi evidenciada a necessidade de revisão no marco legal para a implantação dos CEO pela readequação dos critérios e normas, como também definições de novos padrões e cumprimento de metas para avaliação e monitoramento desses serviços.

This article discusses the evaluation of secondary care in the area of health surveillance. This was a descriptive and normative/evaluative study. Performance analysis drew on secondary data, based on a historical series of dental procedures conducted at the specialized dental clinics implemented in Brazil and recorded by the Outpatient Information System of the Unified National Health System (SIA/SUS) in 2007, as well as primary data from site visits to the clinics, based on questionnaires completed by clinic staff. Performance of the clinics was poor in most regions of the country, and the North of Brazil had the lowest percentage of specialty services implemented. The indicator "Performance of Secondary Care in Oral Health" was 64.4%. The type 3 specialty clinics showed better results in terms of performance and achievement of targets. The study showed the need to review the legal framework for implementing specialized dental clinics by adjusting the criteria and norms, as well as definition of new standards for achievement of goals in the evaluation and monitoring of these services.