Understanding oral health care team performance in primary care: A mixed-method study
Understanding oral health care team performance in primary care: A mixed-method study
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DOI：
10.1371/journal.pone.0217738
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发表时间：
2019-05-30
期刊：
影响因子：
3.7
通讯作者：
Nogueira Guimaraes de Abreuid, Mauro Henrique
中科院分区：
文献类型：
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作者：
Rodrigues Reis, Clarice Magalhaes;Gonzaga Matta-Machado, Antonio Thomaz;Nogueira Guimaraes de Abreuid, Mauro Henrique
本研究旨在描述巴西口腔健康团队(OHTs)开展的初级保健服务，并了解导致不同水平OHTs表现的细微差别。材料与方法采用顺序解释性设计的混合方法研究。在定量阶段，使用来自全国调查(PMAQ-AB)的次要数据来描述12,403个OHTs的工作。应用项目反应理论(IRT)对PMAQ-AB中20个口腔健康问题的心理测量质量进行评价，并对OHT的表现进行鉴定。定量结果指导了定性样品的选择。使用了极端情况抽样策略(结果相反)。OHTs选自巴西贝洛奥里藏特大都会地区，使用IRT测量的分数。数据是通过半结构化访谈收集的。数据分析采用演绎和归纳两种主题分析方法。结果量化结果表明，巴西存在高绩效和低绩效的OHT。IRT分析表明，与假体和口腔癌相关的项目往往会将高性能OHTs与其他OHTs区分开来。定性结果加深了对获得口腔健康服务的了解，并发现了几个获得障碍，如人口的OHTs数量不足，以及除紧急情况外，牙科咨询的等待时间非常长。结论尽管巴西PHC的口腔健康近年来有所扩大，但OHTs仍面临许多挑战，如：准入障碍；口腔癌症病例的预防、早期诊断和随访失败；假体康复不足。
ObjectiveThis study aims to describe the primary care services carried out by Oral Health Teams (OHTs) in Brazil, and to understand the nuances that lead to different levels of OHT performance.Material & methodsA mixed-methods study with a sequential explanatory design was developed. In the quantitative phase, secondary data from a national survey (PMAQ-AB) was used to describe the work of 12,403 OHTs. Item response theory (IRT) was applied, to evaluate the psychometric qualities of 20 oral health questions from PMAQ-AB and to identify the performance of OHT. The quantitative results guided the selection of the qualitative sample. An extreme case sampling strategy was used (opposite results). OHTs were selected from Belo Horizonte metropolitan region in Brazil using scores measured by IRT. Data were collected through semi-structured interviews. Data analysis was conducted using deductive and inductive thematic analysis.ResultsQuantitative results showed that there are OHT with high and low performance in Brazil. The IRT analysis showed that items related to prostheses and oral cancer tend to discriminate high-performance OHTs from other OHTs. Qualitative results deepened the understanding of accessing oral health services and found several access barriers, such as the insufficient number of OHTs for the population, and a very long waiting time for dental consultations other than urgency. The qualitative results confirmed that high-performance OHTs tend to emphasize oral cancer surveillance and deliver prostheses in PHC services.ConclusionDespite the expansion of oral health in PHC in Brazil in recent years, OHTs still face many challenges such as: access barriers; failures in prevention, early diagnosis and follow-up of oral cancer cases; and insufficient rehabilitation with prostheses.