Indicators for teenager's oral health's surveillance

Machado, Flávia Christiane de Azevedo; Souza, Georgia Costa de Araújo; Noro, Luiz Roberto Augusto

doi:10.1590/1413-81232018231.20842015

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Free Themes • Ciênc. saúde colet. 23 (1) • Jan 2018 • https://doi.org/10.1590/1413-81232018231.20842015 copy

Indicators for teenager's oral health's surveillance

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The existence of a few indicators that could guide the evaluation of oral health surveillance in the primary health care attention, mainly in adolescence life cycle, raised the realization of this study. To develop indicators to this end, it was conducted: document analysis to guide the development of a logic model and selection of data to compose indicators. This selection and validation of the logic model were performed by a group of four experts that, from the perspective of the modified Delphi method, analyzed if the model illustrated the activities, results and expected impact of a primary oral health service to enable the adolescents oral health surveillance and assigned points (0-10) to each data proposed. Then, those data judged important by the consensus of experts (média≥7; standard deviation <3) were used to construct indicators. After individual analysis and group discussions, the logical model and 36 of the 48 data, initially proposed, were consensually important, resulting in 26 indicators. The indicators matrix intends to be a situational diagnostic tool to assess, plan and manage health actions to adolescents, but it can be used in other life cycles by its adaptation.

Key words
Oral health; Information systems; Adolescents; Public health surveillance

Proximal subcomponent	Criterion	Data	Delphi (Preconference)		Post Conference
Proximal subcomponent	Criterion	Data	Average	s.d	Average	s.d
COMPONENT: COORDINATION OF CARE SUB-COMPONENT: REGULATION OF ASSISTANCE
Reference and counter-reference	Articulation between the services	Referrals to other professionals	10	0	9	1.41
	Relationship between levels of attention	References to the CEO	9.33	1.15	6.5	4.50
	Routing and the CEO¹ 1 CEO: Center of Dental Specialties;	Time to be serviced	10	0	7.5	5
	Specification of demands sent to the CEO	References to the orthodontist	9	1.41	2.25	4.5
		References to the periodontist	9	1.41	2.25	4.5
		References to maxillo facial surgeon	9	1.41	2.25	4.5
		References to endodontist	9	1.41	2.25	4.5
		References to Prosthodontics	9	1.41	2.25	4.5
		References of patients with special needs	7.5	3.54	2.25	4.5
		Adolescents in treatment in CAPS² 2 CAPS: Center for Psychosocial Care;	10	0	2.25	4.5
COMPONENT: ACCESSIBILITY SUBCOMPONENT: USER EMBRACEMENT
Demand organization	Characteristics of attendances	Adolescents residing in the assigned area	7.5	5	9.5	1
		Adolescents attended at the UBS	10	0	10	0
		First dental appointment	7.25	4.85	6.5	4.43
		Completed treatments	9.75	0.5	9.75	0.5
		Queries to complete treatment	7	4.76	6.75	4.57
	Care deficit	Total of patients on the waiting list	9.5	1	9	1.15
	Home care visits	Home visits to adolescents	10	0	9.5	1
	Precarious link	Adolescents who have abandoned treatment	7.5	2.89	7.5	2.38
Listen qualified	Capturing demands	Diagnosis of eating disorders	8.25	2.36	5.25	3.86
Listen qualified	Capturing demands	Licit and illicit drug users	5	4.08	3.5	4.36
User satisfaction	Satisfaction – collected by ACS³ 3 ACS: Community Health Agent;	Users satisfied with the service provided	10	0	10	0
COMPONENT: INTEGRALITY OF CARE SUBCOMPONENT: QUALITY OF LIFE RELATED TO ORAL HEALTH
Self-perception in oral health	Difficulties in performing activities of daily living	OIDP⁴ 4 OIDP: Oral Impact on Daily Performance - Checking for difficulty in performing activities to: eat, talk, smile, study, sleep, maintain mood, socially relate, perform mouth hygiene due to a problem in the mouth, tooth or prosthesis, and attributed motive to this difficulty. This information should be collected before and at the end of treatment;	8.25	2.36	9.5	1
COMPONENT: INTEGRALITY OF CARE SUBCOMPONENT: PROMOTION, PREVENTION AND RECOVERY
Epidemiology	Epidemiological surveys	Procedure performed in social spaces	10	0	10	0
Oral health care	Supervised brushing	Collective actions carried out by the Oral Health Team	10	0	9.75	0.5
	Assistance actions carried out in social facilities	Non-invasive procedures^* * Non-invasive procedures: cariostatic application for tooth, Topical Application of Fluoride individual, plaque disclosure, provisional restoration.	10	0	9.75	0.5
	Actions by the Oral Health Team	Biopsies	10	0	10	0
	Oral cavity adequacy	Dental restoration	10	0	10	0
	Prevention of oral cancer	Tooth extractions	9.67	0.58	10	0
	Curative actions	Dental scaling	9.75	0.5	10	0
		Dental trauma	9.67	0.58	10	0
		Emergencies	9.67	0.58	10	0
	Non-elective health action	Traumatismo dentário	9.67	0.58	10	0
	Non-elective health action	Traumatismo dentário	9.67	0.58	10	0
COMPONENT: INTEGRALITY OF CARE SUBCOMPONENT: INTERSECTORAL APPROACH
Sanitation and environment	Garbage collection, sewage network, water supply	Garbage collection	7.5	5	4	4.90
		Coverage of the sewage network in municipality	7.5	5	4	4.90
		Presence of fluoridated water	7.5	5	5	5.77
		Concentration of fluoride in water	7	4.76	5	5.77
Multiprofessional teams	Actions carried out by multidisciplinary team	Collective actions carried out with multidisciplinary team	10	0	10	0
COMPONENT: INTEGRALITY OF CARE SUBCOMPONENT: STRATEGIC MANAGEMENT
Professional training	Courses and training	Semester courses for the Oral Health Team	8	2.16	3.25	3.95
		Semi-annual trainings for the Oral Health Team	8.25	2.362	5	3.56
		Semi-annual training to other professionals in the ESF⁵ 5 ESF: Family Health Team;	8	2.16	3.25	3.94
		Professionals who have made specialization after entry into service	9.5	1	6	4.55
Situational diagnosis	Monthly feed of the information system: SIAB⁶ 6 SIAB: Basic Attention Information System.	Feed of the information system	7.5	5	5	5.77
	Suspension of the transfer of funds	Suspension of the transfer of funds	6.25	4.79	4.5	5.26
	Establishment of interpersonal relationship	Professionals with more than one year in the Family Health Unit	6	2	4	2.70
	Precariousness of labour relations	Professionals with an effective link in the Family Health Unit	8.25	2.36	5	3.74
Participation of the population	Planning	Multiprofessional planning meetings	10	0	9.75	0.5
Participation of the population	Planning	Meetings with users	8.75	2.5	7.5	2.89

Criterion	Bookmark	Objective	Source	Method of calculation
Proximal subcomponent: Reference and counter reference
Articulation between services	Proportion of adolescents referred by the dentist to other professionals in Primary Care	To quantify references to other professionals in Primary Care from the perspective of teamwork and intersectoral approach	SIA¹ 1 SIA: Outpatient Information System; SIAB² 2 SIAB: Basic Attention Information System;	Number of referrals of adolescents conducted by the dentist to other Primary Care professionals divided by the total number of Primary Care attendances x 100 (every six months)
Proximal subcomponent: Demand organization
Characteristics of health care	Proportion of adolescents resident in the assigned area attended by OHT³ 3 OHT: Oral Health Team;	To quantify the access demand within the group of adolescents	SIAB ⁴ 4 IBGE: Brazilian Institute of Geography and Statistics;	Number of first dental appointments in adolescents divided by the total of adolescents x 100 (every six months)
	Proportion of adolescents attended by OHT	To quantify the frequency of access of adolescents in the general population	SIAB	Total number of first dental appointments in adolescents divided by the total number of first dental appointments in the general population x 100 (every six months)
	Proportion of dental care completed in adolescents	To evaluate the efficaciousness of access within the group of adolescents	PMAQ⁵ 5 PMAQ: National Program for Improving Access and Quality of Primary Care; (modified)	Number of completed treatments in adolescents divided by the number of first dental appointments in adolescents x 100 (every six months)
Deficits of attendances	Proportion of adolescents attended by OHT in the universe of demands	Check the service deficit	SIAB Primary data	Total number of first dental appointments in adolescents divided by the number of patients on the waiting list x 100 (every six months)
Home visits	Proportion of home care visits of OHT targeting adolescents	To identify new forms of care, breaking with the passivity of the traditional units of primary care and establishing linkages and approaches with adolescents and their families, interacting with home spaces	Primary source (adapted from SIAB)	Number of home care visits of the OHT to the adolescents divided by the number of home visits performed x 100 (every six months)
Precariousness of labour relations	Proportion of adolescents who have left the dental treatment program	To identify the abandonment of adolescents to dental treatment	Primary source SIAB	Number of adolescents who have left the treatment divided by the number of first dental appointments in adolescents x 100 (every six months)
Proximal subcomponent: User satisfaction
Satisfaction – collected by ACS⁶ 6 ACS: Community Health Agent;	Proportion of adolescents satisfied with the attendance of OHT	To measure the satisfaction of adolescents with the attendance by OHT	PMAQ	Number of adolescents users satisfied with the service provided by OHT divided by the total number of first dental appointments in adolescents x 100 (every six months)
Proximal subcomponent: Self-perception in oral health
Difficulties in performing activities of daily living	OIDP⁷ 7 OIDP: Oral Impact on Daily Performance;	Check efficaciousness of attention; To identify difficulties by adolescents even after completion of dental care, from the perspective of qualified listening	SIAB	Number of adolescents who reported some difficulty related to mouth divided by the number of complete dental treatments in adolescents x 100 (every six months)
Proximal subcomponent: Epidemiology
Oral needs surveys	Coverage of epidemiological surveys of oral health	To articulate health services to social facilities with the intersectoral approach	Primary sources; SIA	Number of school adolescents participating in an epidemiological survey of oral health divided by the total number of adolescents enrolled in schools x 100 (every six months)
	Proportion of adolescents with oral needs detected in epidemiological surveys	To articulate health services to social facilities with the intersectoral approach	Primary sources; SIA	Number of school adolescents with dental treatment needs identified in epidemiological surveys divided by the number of adolescents investigated in epidemiological surveys of oral health at school x 100 (every six months)
	Proportion of adolescents who accessed the dental service with oral needs collected in epidemiological surveys	Verify the effectiveness of intersectoral approach in expanding access to the service	PMAQ; Primary data	Total number of first dental appointments in adolescents per semester divided by the number of adolescents with oral health needs identified in surveys x 100 (every six months)
Proximal subcomponent: Oral health Care
Supervised brushing	Coverage of supervised dental brushing in adolescents	To verify coverage of supervised brushing in the adolescent population	SIAB IBGE	Number of adolescents participating in the supervised brushing dental collective action divided by the total number of adolescents in the area x 100 (every six months)
Assistance actions carried out in social facilities	Coverage of educational actions of oral health in adolescents by the multiprofessional team	To verify coverage of oral health educational actions in adolescents from the perspective of multidisciplinary teamwork	Primary source	Number of educational actions directed to the adolescent carried out with the participation of multiprofessional team
Actions taken by OHT	Coverage of educational actions of oral health in adolescents	To verify coverage of oral health education in adolescents	Primary source	Number of adolescents who participated in educational activities of oral health conducted by OHT divided by the total number of adolescents in the area x 100 (every six months)
Oral cavity adequacy	Average noninvasive procedures performed at school and in other social spaces in adolescents	To verify the effectiveness of intersectoral approach in expanding access to the service	Primary sources; SIA	Number of adolescents who underwent oral procedures at school and in other social spaces divided by the total number of adolescents of the area x 100 (every six months)
Oral cavity adequacy	Proportion of non-invasive procedures in adolescents	To observe the modification of a curativist for a preventive model	SIA (Colussi and Calvo, 2011)³³33. Colussi CF, Calvo MCM. Modelo de avaliação da saúde bucal na atenção básica. Cad Saude Publica 2011; 27(9):1731-1745.	Number of non-invasive procedures in adolescents divided by total procedures in adolescents x 100 (every six months)
Preventive actions of oral cancer	Proportion of biopsies performed in adolescents	Capture demands	SIA	Number of biopsies on soft tissues of the mouth made in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
Curative actions	Proportion of restorative procedures in adolescents	Capture demands	SIA	Number of dental restorations performed in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
	Proportion of dental extractions performed in adolescents	Capture demands	SIA	Number of tooth extractions (deciduous and permanent teeth) performed in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
	Proportion of dental scaling conducted in adolescents	Capture demands	SIA	Number of dental scaling conducted in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
Non-elective health action	Proportion of trauma cases in adolescents	Capture demands	SIA	Number of dent-alveolar traumatisms cases in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
Non-elective health action	Proportion of emergency consultations in adolescents	Capture demands	SIA	Number of dental consultations of urgency in adolescents divided by the number of dental care performed in adolescents x 100 (every six months)
Proximal subcomponent: Multiprofessional teams
Actions carried out by multiprofessional team	Coverage of actions carried out by multiprofessional team	To verify coverage of actions carried out by multiprofessional team	Primary source	Number of adolescents who participated in actions carried out by multiprofessional team divided by the total of adolescents in the area x 100 (every six months)
Proximal subcomponent: Participation of the population
Planning	Proportion of multiprofessional planning meetings	To capture demands	Primary source	Number of multiprofessional planning meetings of the ESF⁸ 8 ESF: Family Health Team. divided by the number of meetings (every six months)
Planning	Proportion of meetings with users to grasp problems and guide planning	To capture problems and guide planning in the context of co-management and user participation	SIA	Number of meetings held by the ACS which participation of 10 or more people, with a minimum duration of 30 minutes in order to disseminate information, discuss strategies of overcoming health problems or to contribute to the community organization divided by the number of scheduled meetings (every six months)

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

FCA Machado and GCA Souza participated in the conception, design, analysis, interpretation of data, article and review, LRA Noro participated in the analysis and interpretation of data, article writing and critical review.