Validation of the Brazilian version of Primary Care Assessment Tool (PCAT) for Oral Health - PCATool Brazil Oral Health for Professionals

D’Avila, Otávio Pereira; Harzheim, Erno; Hauser, Lisiane; Pinto, Luiz Felipe; Castilhos, Eduardo Dickie de; Hugo, Fernando Neves

doi:10.1590/1413-81232021266.23432020

Otávio Pereira D’Avila otaviopereiradavila@gmail.com

Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. R. Gonçalves Chaves 457, Centro. 96015-560 Pelotas RS Brasil.

https://orcid.org/0000-0003-1852-7858

Erno Harzheim

Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil.

https://orcid.org/0000-0002-8919-7916

Lisiane Hauser

Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil.

https://orcid.org/0000-0003-3324-5533

Luiz Felipe Pinto

Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil.

Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil.

https://orcid.org/0000-0002-9888-606X

Eduardo Dickie de Castilhos

Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. R. Gonçalves Chaves 457, Centro. 96015-560 Pelotas RS Brasil.

https://orcid.org/0000-0002-7072-6558

Fernando Neves Hugo

Programa de Pós-Graduação em Odontologia, UFRGS. Porto Alegre RS Brasil.

https://orcid.org/0000-0003-2222-7719

otaviopereiradavila@gmail.com

Chief Editors: Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Collaborations

OP D’Avila, FN Hugo and E Harzheim contributed to the design, execution, development and final review of the study. L Hauser, LFS Pinto were responsible for the execution and review of the data analysis as well as the final review of the results. ED Castilhos contributes to the final revision of the article, textual adjustments and improvement of the data discussion.

Attributes of Primary Health Care		Item-total correlation	Factorial Loading
First Contact Access - Accessibility
A1	Is your oral health service open on Saturdays or Sundays?	-	-0,12^* * Items removed from the final instrument,
A2	Is your oral health service open at least a few working day evenings until 8:00 p.m.?	-	0,00^* * Items removed from the final instrument,
A3	When your oral health service is open,and any of your patients has an issue with their mouth or teeth, does someone at the service see that person on the same day?	0,20	0,27^ Items conceptually included in the final instrument.
A4	When your oral health service is open, do patients get quick guidance over the phone when deemed necessary?	0,31	0,58
A5	When your oral health service is closed, is there a phone number that patients can call when they have an issue with their mouth or teeth?	0,37	0,37
A6	When your oral health service is closed on Saturdays and Sundays,and some of your patients have a mouth or tooth issue, does someone at your service see that person on the same day?	0,33	0,44
A7	When your oral health service is closed and any of your patients have a mouth or teeth issue during the night, does anyone at your service see that person on that same night?	0,27	0,75
A8	Is it easy for a patient to schedule a routine check-up appointment at your oral health service?	0,24	0,71
A9	On average, do your patients have to wait more than 30 minutes to be seen by the dentist (already discounting screening or admission processes)?	0,19	0,40
B1	In your health service, are patients always seen by the same dentist?	0,17	0,47
B2	Can you understand the questions asked by your patients?	0,31	0,45
B3	Do you think your patients understand what you are saying or asking?	0,26	0,37
B4	If your patients have a question or concern, can they call and talk to the dentist who knows them best?	0,24	0,58
B5	Do you give your patients enough time to talk about their concerns or problems?	0,37	0,51
B6	Do you think your patients are comfortable telling you about their concerns and problems?	0,39	0,52
B7	Do you think you know the patients in your health service "very well"?	0,52	0,66
B8	Do you know who lives with each of your patients?	0,52	0,5
B9	Do you understand which problems are most important to the patients you care for?	0,35	0,42
B10	Do you know the complete oral health history of each patient?	0,44	0,40
B11	Do you know each patient's job or work?	0,44	0,48
B12	Would you know if your patients did not get the prescribed medications or struggle to pay for them?	0,33	0,32
B13	Do you know all the medications your patients are taking?	0,29	0,35

Attributes of Primary Health Care		Item-total correlation	Factorial Loading
Coordination - Care Integration
C1	Does your oral health service communicate or deliver every laboratory test results to your patients?	-	0,21^* * Items removed from the final instrument,
C2	Do you know all the appointments your patients make with specialists or specialized services?	0,22	0,38
C3	When your patients need a referral, do you discuss with your patient different services where they could be checked?	-	0,26^* * Items removed from the final instrument,
C4	Does anyone in your health service help you make an appointment for a referral?	0,31	0,46
C5	When your patients are referred, do you give them any written information to take to the specialist or specialized service?	0,26	0,45
C6	Do you get from the specialist or specialist service useful information about the referred patient?	0,38	0,50
C7	After the appointment with the specialist or specialized service, do you talk to your patient about the results of the appointment?	0,33	0,51
Coordination - Information Systems
D1	Do you ask your patients to bring their past oral health records or patient charts? (emergency records with a dentist, teeth x-rays)	0,29	-0,10^ Items conceptually included in the final instrument.
D2	Would you allow your patients to check your medical records if they wanted to?	0,14	0,21^ Items conceptually included in the final instrument.
D3	Are your patient records always available when you see them?	0,08	0,31^ Items conceptually included in the final instrument.

Attributes of Primary Health Care		Item-total correlation	Factorial Loading
Comprehensiveness - Available Services
E1	Preventive examination of the mouth (oral cancer)	-	0,26^* * Items removed from the final instrument.
E2	Teeth filling or obturation	0,42	0,53
E3	Exodontia or tooth extraction	0,47	0,51
E4	Application of fluoride on the teeth and guidance on its use	-	0,28^* * Items removed from the final instrument.
E5	Gum disease treatment	0,40	0,43
E6	Emergency care in cases of pain, bleeding or trauma/accident/impact	0,35	0,37
E7	Treatment and guidance for people with bad breath	0,49	0,54
E8	Care provided to the pregnant woman by the dentist/antenatal dental consultation	0,41	0,46
E9	Treatment and guidance for canker sores	0,46	0,56
E10	Guidance on how to take care of dental prostheses	0,58	0,64
E11	Guidance for the treatment of symptoms in cases of temporomandibular joint pain	0,51	0,51
E12	Nutrition and diet advice	0,46	0,37
E13	Treatment and guidance in case of pericoronitis	0,51	0,58
E14	Oral health treatment and guidelines for disabled patients	0,43	0,37
E15	Counseling on how to stop smoking	0,46	0,35
E16	Oral health treatment and guidance for patients who are bedridden or unable to leave their homes	-	0,24^* * Items removed from the final instrument.
E17	Guidance about issues that may occur with mouth piercings	0,47	0,39
E18	Orientation and referral of people who mouth breathe for medical treatment	0,57	0,46
E19	Guidance on herpes simplex	0,65	0,68
E20	Orientation and referral of people with malformations in the lip and roof of the mouth (hare lip, cleft palate, cleft lip).	0,53	0,5
E21	Guidance on changes in food taste/palladate	0,68	0,59
E22	Guidance for people with bruxism	0,70	0,75
E23	Guidance on eating disorders/eating problems	0,55	0,42
E24	Guidance on fluorosis-caused issues	0,65	0,71
E25	Oral health guidance for caregivers of bedridden or disabled patients	0,51	0,38
E26	Oral Health Care and Guidance for People with Hypertension and/or Diabetes	0,60	0,63
Comprehensiveness - Services Provided
F1	Mouth examination / teeth examination / dental examination	0,39	0,37
F2	Guidance on habits that can damage mouth and teeth (nail biting, cheek biting, instance)	0,58	0,37
F3	Guidance on what to do to prevent oral cancer,	0,59	0,46
F4	Treatment and guidance on tooth wear	0,54	0,48
F5	Guidance on medications that interfere with the mouth	0,56	0,42
F6	Guidelines on how to perform oral hygiene (brushing/flossing)	0,42	0,49
F7	Health education activities at the health facility or in the community (groups, workshops, lectures)	-	0,12^* * Items removed from the final instrument.
F8	Guidance on changes that occur in the mouth with aging	0,56	0,45
F9	Guidelines on the water you drink	-	0,24^* * Items removed from the final instrument.

Attributes of Primary Health Care		Item-total correlation	Factorial Loading
Family Orientation
G1	You ask your patients about their ideas and opinions when planning treatment and care for them or for a family member.	0,48	0,41
G2	You ask about common ailments or issues that can occur in your patients' families (mouth cancer, diabetes, high blood pressure, smoking, alcoholism?).	0,43	0,44
G3	Are you willing and capable of seeing your patients' family members to discuss a health problem?	0,44	0,40
G4	Do you use genograms and/or other instruments to evaluate family functioning?	-	0,28^* * Items removed from the final instrument.
G5	Do you have discussions about familiar risk factors of your patients? Ex: Genetic	-	0,61^* * Items removed from the final instrument.
G6	Do you discuss social risk factors with your patients, e.g. loss of employment?	0,42	0,67
G7	Do you discuss the living conditions with your patients, e.g. a refrigerator in operating conditions?	-	0,59^* * Items removed from the final instrument.
Community Orientation
H1	Do you make home visits?	0,49	0,32
H2	Do you believe that your health service has proper knowledge on health issues of its community?	0,51	0,33
H3	Does your health service community take into account opinions and ideas on how to improve health services?	0,51	0,37
H4	Can your health service adapt oral health services or programs to address specific community-related health issues?	-	0,32^* * Items removed from the final instrument.
H5	Patient surveys	0,61	0,36
H6	Community surveys	0,68	0,38
H7	"Feedback" from community organizations or health management boards	0,67	0,50
H8	"Feedback" from the healthcare team	0,64	0,46
H9	Systematic evaluations of programs and services provided	0,44	0,41
H10	Presence of users in the Local Health Council (Management Council or Users Council)?	0,54	0,46
H12	An intersectional cooperation network with state and local agencies involved in culturally diverse groups	0,53	0,49
H13	Associations with religious services/organizations	0,53	0,52
H14	Involvement with the associations/community leaders of the residents	0,50	0,54
H15	Community workers or members of the managing council/district health council	0,44	0,37
Cultural Competence
I1	If necessary, do you take into account family beliefs on health care or the use of traditional/popular medications, such as herbs/home medicine?	0,11	0,32
I2	If necessary, do you consider the request from a family to use complementary treatments such as homeopathy or acupuncture?	-	0,32^* * Items removed from the final instrument.
I3	Staff training by external trainers	0,58	0,68
I4	Service training provided by the team itself	0,71	0,79
I5	Use of culturally sensitive materials/pamphlets (posters, appropriate language, religious customs)	0,61	0,67
16	Team reflecting the cultural diversity of its population	0,74	0,77
I7	Service planning that reflects cultural diversity	0,77	0,79

Attributes of Primary Oral Health Care	Primary Health Care Scores^* * The scores assume values between 0-10.	Standard deviation	Cronbach's Alpha	Success rate of the scale (%)	P^# # Associated with Wilcoxon signed-rank test. -value for Test-Retest
First Contact - Accessibility	4,4	1,46	0,55	88%	0,18
Continuity	6,7	1,23	0,74	96%	0,39
Coordination of Care	7,6	1,57	0,55	93%	0,38
Coordination - Information System	7,7	1,57	0,21	21%	0,91
Comprehensiveness - Services Available	8,9	1,12	0,91	100%	<0,001
Comprehensiveness - Services Provided	9,2	1,07	0,80	100%	0,32
Family Orientation	7,5	1,93	0,66	94%	0,65
Community Orientation	4,8	2,20	0,87	100%	0,39
Cultural Competence	5,0	2,53	0,81	90%	0,18

[1] otaviopereiradavila@gmail.com

Brasil

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Abstract