Análise da gestão da rede de atenção em saúde bucal no Brasil e os impactos da Covid-19 nos serviços especializados

Abstract

Access to dental services has been impacted by the COVID-19 pandemic, requiring public managers to redefine flows and protocols and reorganize the healthcare network at all levels of care. Given this scenario, the objective was to analyze the changes in oral health management resulting from the COVID-19 pandemic in relation to Brazilian municipalities with Dental Specialty Centers. To this end, three studies were conducted: the first was a qualitative approach, with semi-structured interviews, which sought to understand the challenges and strategies implemented by oral health managers to meet the demands of dental care in the state of Minas Gerais. The results highlighted the importance of technical documents and vaccination in resuming a verticalized management model, but with an understanding of the need to acquire knowledge of planning, bidding, and public budgeting. The second was an ecological observational study based on the correlation of specialized procedures in endodontics, periodontics, and oral surgery with structural indicators (primary health care and oral health coverage), care indicators (total number of first scheduled dental appointments), and socioeconomic indicators (Municipal Human Development Index, Gini Index, occupancy rate, average salary, and GDP per capita) of Brazilian municipalities with Dental Specialty Centers, between 2019 and 2021. It was observed that, in 2019, the inclusion of social variables did not promote a relevant improvement in the explanation of the model, but that in 2020 and 2021 there was a significant improvement in this adjustment, which was not repeated for the care and structural indicators. The third was an ecological observational study on the provision of specialized dental procedures from 2019 to 2023 and an analysis of the overall performance of Brazilian municipalities with Dental Specialty Centers in meeting their goals. The annual CGM calculation revealed regular performance in all Brazilian regions (North, Northeast, Midwest, Southeast, and South). And, analyzing the years 2019 and 2023, there was low productivity recovery power in the three specialties considered. It was concluded that the unprecedented nature of the pandemic led to episodic changes in work processes and oral health management, with the need to acquire knowledge in planning, bidding, and public budgeting, in addition to reduced productivity in Dental Specialty Centers and poor performance related to the achievement of goals in Brazilian municipalities