ABSTRACT
OBJECTIVES: To assess which factors were associated with the achievement of endodontic goals. METHODS: Cross-sectional study using secondary data from the second cycle of the Program for the Improvement of Access and Quality in the dental speciality centres-in Portuguese PMAQ-CEO. The independent variables extracted from this database were related to dental speciality centres (CEO in Portuguese). In addition, variables referring to the CEO host city were incorporated into the model. The outcome variable was the number of endodontic goals achieved calculated from the production of the CEO available in the Ambulatory Health Information System in 2018. Descriptive analyses and multilevel Poisson regression were performed with the software SPSS 23.0 and STATA 14.0. RESULTS: CEOs with more than 20% of patients' absenteeism were 26% less likely to reach the goals of the endodontics specialty; CEOs with availability of endodontists for more than 40 hours a week were two times more likely to reach the goals than those with less than 40 hours in endodontics specialty. CEOs with a waiting time for endodontic procedures greater than 45 days achieved a number of goals 31% lower than those with a waiting time up to 45 days. CEO type I and CEO type II showed 2.10 and 1.20 higher likelihood to reach the number of goals of the endodontics specialty than CEO type III. The number of endodontic instruments in sufficient number was positively associated with the achievement of goals. CEOs located in municipalities that reached more than 5% in the supervised brushing indicator had 2.26 greater likelihood to achieve the goals than those that did not reach this percentage. CONCLUSION: Contextual and local determinants are associated with the achievement of goals in the endodontic specialty in the dental speciality centres in Brazil.
Subject(s)
Endodontics , Goals , Brazil , Cross-Sectional Studies , Humans , Multilevel AnalysisABSTRACT
A avaliação pode ser definida como um julgamento em que se emite um juízo de valor para auxiliar na tomada de decisão. O Estudo de Avaliabilidade (EA) é um estudo pré-avaliativo que precede a avaliação propriamente dita de um serviço. Em 2004, a Política Nacional de Saúde Bucal foi instituída e, visando cumprir o princípio da integralidade, a atenção secundária em saúde bucal foi fortalecida e os Centros de Especialidades Odontológicas (CEO) foram implantados. Após 16 anos de implantação desse serviço, faz-se necessário avaliá-lo para identificar suas potencialidades e fragilidades e assim corrigir possíveis falhas e estabelecer novas metas. Em 2016, iniciou-se o EA dos CEO dentro do Programa de Mestrado Profissional em Odontologia em Saúde Pública da UFMG. Este trabalho corresponde à continuação do EA, referente à última fase do estudo, o processo de validação do instrumento de avaliação. Assim, este trabalho teve por objetivo validar um instrumento de avaliação dos CEO no Brasil, através de um EA. Trata-se de um estudo metodológico de abordagem quali-quantitativa desenvolvido entre 2019-2020. Foi realizado o alinhamento conceitual da matriz de medidas e análises, previamente desenvolvida na primeira etapa do EA, por meio de uma oficina de consenso. A partir da matriz consensuada, foi elaborado o instrumento de avaliação do CEO, um questionário com perguntas avaliativas de múltipla escolha. O questionário foi validado em aparência e conteúdo através da Técnica de Delphi, de acordo com os critérios de relevância, objetividade e clareza. Participaram de todo o processo 19 informantes-chaves/juízes, especialistas na área do estudo, sendo eles professores universitários, profissionais do CEO, avaliadores do PMAQ-CEO e profissionais do serviço público. Os dados foram analisados qualiquantitativamente. Para análise quantitativa, foi utilizado o software SPSS Statistics, versão 23.0. Para identificar o grau de concordância entre os especialistas foi utilizado o Índice de Validade de Conteúdo (IVC). As questões que não obtiveram consenso acima de 75%, em pelo menos um dos três critérios, foram reformuladas. O questionário, elaborado a partir da versão final da matriz de medidas e análises, foi validado através de duas rodadas de avaliação. Ao todo, foram excluídas três questões e reformuladas outras seis. Na primeira rodada, o IVC médio para os critérios clareza, objetividade e relevância foram, respectivamente, 78,7%, 86,9% e 92,1%. Na segunda rodada, ficaram em 88,5%, 85,0% e 91,0%. A versão final do questionário apresentou 57 questões. Como produto técnico deste estudo, foi elaborado um documento com o questionário e um tutorial para o seu preenchimento, que está em processo de discussão junto às Secretarias de Saúde Municipal de Belo Horizonte e Estadual de Minas Gerais, com vistas à incorporação do produto junto aos serviços de atenção secundária em saúde bucal. Em síntese, o instrumento de avaliação do CEO foi validado neste EA e poderá favorecer os processos de autoavaliação, planejamento e monitoramento das ações desse serviço, com possíveis implicações positivas sobre o processo de trabalho.
Evaluation can be defined as a judgment in which a value is transmitted to assist in decision making. The Evaluation Study (ES) is a pre-evaluation study that precedes the evaluation of a service. In 2004, the Brazilian National Oral Health Policy was instituted and, in order to comply with the principle of integrality, secondary oral health care was strengthened and the Dental Specialty Centers (DSC) were implemented. After 16 years of implementing this service, it is necessary to evaluate it to identify its strengths and weaknesses and thus correct possible failures and establish new goals. In 2016, the ES of DSC started in the Professional Master's Program in Public Health Dentistry of UFMG. This work corresponds to the continuation of the ES, referring to the last phase of the study, the validation process of the evaluation tool. Thus, this work aimed to validate an evaluation tool of the Dental Specialty Centers (DSC) in Brazil, through an ES. This is a methodological study with a qualitative and quantitative approach developed between 2019-2020. The conceptual alignment of the measurement and analysis matrix, previously developed in the first stage of the ES, was carried out through a consensus workshop. From the consensual matrix, the DSC's evaluation tool was developed, a questionnaire with multiple-choice evaluative questions. The questionnaire was validated in appearance and content using the Delphi Technique, according to the criteria of relevance, objectivity and clarity. Nineteen key informants / judges, experts in the study area, participated in the whole process, such as university professors, DSC professionals, PMAQ-CEO (in English, National Program for Improving Access to and Quality of Dental Specialty Center) evaluators and public service professionals. Data were analyzed qualitatively and quantitatively. For quantitative analysis, SPSS Statistics software versão 23.0 was used. To identify the degree of agreement between the experts, the Content Validity Index (CVI) was used. The questions that did not reach consensus above 75%, in at least one of the three criteria, were reformulated. The questionnaire, created from the final version of the measurement and analysis matrix, was validated through two evaluation rounds. Altogether, three questions were excluded and six others were reformulated. In the first round, the mean CVI for the criteria of clarity, objectivity and relevance were, respectively, 78.7%, 86.9% and 92.1%. In the second round, they were 88.5%, 85.0% and 91.0%. The final version of the questionnaire had 57 questions. As a technical product of this study, a document was prepared with the questionnaire and a tutorial for completing it, which is under discussion with the Health Departments of Belo Horizonte city and of Minas Gerais State, with a view to incorporating the product with the secondary oral health care services. In summary, the DSC's evaluation tool has been validated in this ES and may favor the self-assessment, planning and monitoring processes of this service's actions, with possible positive implications for the work process.
