Avaliação do serviço de saúde bucal da estratégia saúde da família de Fortaleza durante a pandemia de Covid-19

Abstract

The COVID-19 pandemic required changes in the routine of dental care that represented obstacles and could worsen the challenge of incorporating the principles of Primary Health Care (PHC) into the oral health service of the Family Health Strategy (FHS). Therefore, the objective of the study was to evaluate the oral health service of the FHS in the city of Fortaleza during the COVID-19 pandemic. An evaluative, cross-sectional study was carried out with a quantitative approach with 531 users, 157 dental surgeons, and an evaluation with a qualitative approach with 7 oral health coordinators. Dentists who were permanent employees and who had worked at the health units for at least 2 years and users over 18 years of age who had also used the service at the unit for at least 2 years were included. To evaluate the oral health service, the Primary Care Assessment Tool oral health version (PCATool SB) was used as an instrument, with scores classified as high (≥ 6.6) and low (<6.6). The data were analyzed using the SPSS program, considering a 95% confidence interval, with a significance level of 5%. Descriptive analysis of the data was performed, in addition to using the Student's T test, ANOVA and multifactorial ANOVA. The qualitative approach was carried out through interviews with all oral health coordinators in Fortaleza, addressing questions about the oral health service work process during the COVID-19 pandemic. The qualitative analysis was carried out through content analysis, identifying analytical categories. The project was approved by the Research Ethics Committee (CEP) of the Federal University of Ceará (UFC). The evaluation of the municipality's oral health service by professionals and users was negative, being deficient mainly for the first contact access attribute. There was a difference in evaluation between the Regional Health Coordinators (CORES) and there was also an influence of sociodemographic factors and those related to the Primary Health Care Unit (PHCU) service in the evaluation of users. During the analysis of managers' perception, two analytical categories were identified with their respective subcategories:1. The pandemic context: attitudinal and emotional reactions (1.1 First contacts with the pandemic: dealing with the unknown and challenges; 1.2 Impact on mental health) and 2. The new work process (2.1 Management and impact of decision-making; 2.2 Redefinition of professional roles; 2.3 Adaptations in the service and care for safety and biosafety). Regarding the perception of the study managers, they perceived the pandemic moment as challenging, with fluctuations in the decision-making process, however, the planning process was carried out collaboratively with service professionals. Challenges were revealed along the way, such as having to deal with the unknown, material difficulties and negative impacts on the implementation of PHC attributes in the service. The moment encouraged the redefinition of professional roles, demonstrating sensitivity on the part of professionals and managers to welcome colleagues and patients, as well as good performance and integration in the face of the new work process built from the context. Regarding the perspective of dentists and users, the service was evaluated negatively during the pandemic, with access being the worst evaluated aspect, signaling the need to prioritize management for this attribute .