Teleodontologia como ferramenta para atenção à saúde bucal do adolescente

MESQUITA, Mariane Nunes de; MACIEL, Jacques Antonio Cavalcante; SILVA, Antonia Rita de Cássia da

RESUMO

A adolescência compreende um ciclo de vida com alto contato com ferramentas tecnológicas de informação e comunicação. Por este motivo optou-se pela incorporação dessas ferramentas no processo de trabalho em saúde bucal voltado a este público. A pandemia de COVID-19 contextualizou a utilização de ferramentas tecnológicas digitais em diversos setores produtivos, incluindo a assistência à saúde bucal no Sistema Único de Saúde.

Objetivos:

Objetivou-se estimular o uso da teleodontologia na atenção à saúde bucal de adolescentes na Atenção Primária à Saúde do interior do Ceará.

Métodos:

Os participantes foram adolescentes entre 12 e 15 anos de duas microáreas do território, totalizando 25 participantes. A intervenção foi dividida em três etapas: a aplicação de um formulário eletrônico, criação de um grupo de aplicativo de mensagens instantâneas e criação com ampliação de um fluxo para acesso ao serviço.

Resultados:

Os motivos da evasão em consultas odontológicas pelos adolescentes foram a falta de vagas, o longo tempo de espera e o baixo número de ações educativas voltadas à saúde. No grupo do aplicativo de mensagens, foram realizadas atividades educativas remotas, assim como restruturação do fluxo de atendimento com a possibilidade de marcação de primeira consulta através do grupo.

Conclusão:

A interação obtida na intervenção favoreceu a melhoria do acesso às consultas odontológicas.

Termos de indexação
Adolescente; Saúde bucal; Teleodontologia

[1] Correspondence: MN Mesquita. E-mail: marianemn@hotmail.com.

EXPLANATORY MOMENT
In this, it was sought to analyze the health situation, for problems to be identified and prioritized according to importance, urgency and coping capacity. The problem identified and selected for discussion is described in more detail in Table 2 (Ishikawa Diagram). At this point in the PES, it is also necessary to identify critical nodes (causes) that make it difficult to solve the problem addressed. And these were distributed as: immediate causes (the least complex to be solved), intermediate and distant causes (the most difficult to solve): Immediate/closer causes: low number of educational actions aimed at adolescent health carried out by the local health team; lack of knowledge on how to schedule an appointment; fear of dental treatment; the lack of knowledge by the oral health team about causes of adolescents evasion to dental appointments. Intermediate causes: Difficulties encountered when seeking assistance, such as lack of vacancies and long waiting times. Distant causes: low education level of the adult population responsible for adolescents.
NORMATIVE MOMENT
This moment will contemplate the elaboration of the objective-situation, built from the decision about what to do in the political time available to the actor to face the selected problems [⁶6 Teixeira CF (org.). Planejamento em saúde: conceitos, métodos e experiências. Salvador: EDUFBA; 2010.]. Analyzing the causes related to the problem, it was observed that most of them can be solved, being of low complexity and related to the work process of the service professionals and the way life community. For the action plan, the immediate and intermediate causes were selected, due to the coping capacity of responsible for the actions. The expected results will be presented through the objectives described in the strategic moment stage, as well as the viability analysis for these results/objectives to be achieved.
STRATEGIC MOMENT
This describ the definition of the operations to be carried out (action plans), with the design of the Operation-Problem Modules contemplating the viability analysis of each one proposed operations [⁶6 Teixeira CF (org.). Planejamento em saúde: conceitos, métodos e experiências. Salvador: EDUFBA; 2010.].
Action Plan 1
Closest causes: The lack of knowledge by the oral health team about evasion causes of adolescents to dental appointments.					Objectives: To identify the reasons that lead adolescents not to seek dental care at the UAPS
Responsible or Operation Manager: Resident dentist
Action 1		Necessary resources		Responsible		Frequency			Mark
To carry out an active search of adolescents aged between 12-15 years old to apply an online form and participate at a project for adolescents		Materials: each participant has a cell phone or computer at home; website Google forms		Resident dentist ACS of the microareas involved		2 months in active search (September and October 2021) After each participant received the link, the form would be answered only once, taking about 5 minutes			At least 50% of teenagers who received the link answer to the form
Action Plan 2
Closest causes: low number of educational actions aimed at adolescent health carried out by the local health team; Lack of knowledge on how to schedule an appointment; Fear of dental treatment			Objectives: to increase the number of educational actions, through digital media (teleodontology), aimed at adolescent health; the performance of informational acts, through digital media (teleodontology), sharing how the flow of dental care works; a gradual increase in the number of dental appointments for adolescents.
Responsible or Operation Manager: Resident dentist
Action 2		Necessary resources		Responsible			Frequency		Mark
Create a WhatsApp Group for teenagers (rotating teenagers between 12 and 15 years old in the territory.) Relevance topics to the age group are addressed, such as adolescence obesity, oral hygiene guidelines, adolescent immunization, prejudice and social inclusion.		Materials: a cell phone capable of Whatsapp in each adolescent user’s home; Cell phones of resident professionals; Website “Quizur” for creating games and social interaction. Humans: resident health professionals (dentist, physiotherapist, social worker, nutritionist, psychologist and nurse); ACSs responsible for the 2 micro-areas in which the project operates		Resident health professionals (dentist, physiotherapist, social worker, nutritionist, psychologist and nurse)			One content per week, for 3 months (November 2021 to January 2022)		Interaction between the participants, dentist and ACSs. And permanence of at least 70% of the participants included it will be observed if there was an increase of dental consultations for adolescents in this age group over the months.
Activities (digital media contents weekly): • Oral hygiene orientations • Oral diseases: gingivitis and periodontitis • Obesity in adolescence • Social inclusion and prejudice • Mental health in focus: depression and suicide • Domestic and sexual violence • Immunization in adolescence • Physiotherapy focused on adolescent health: physical exercise and posture • Care of my toothbrush • Myths and truths about oral health.
Action Plan 3
Intermediate cause: low number of vacancies for a high number of users					Expected Result: increase in the number of vacancies for local users and reduction of waiting lines
Responsible or Operation Manager: UAPS health coordinator
Action 3	Necessary resources		Responsible			Frequency		Mark
Action: implement another oral health team	Materials: adjustments to the physical structure of the dental office (dental sucker repair and make a purchase of a new dental compressor) Humans: Hire another dentist and oral health auxiliar		Current oral health team Health Unit Coordinator health secretary municipal mayor			–		That the implantation takes place within 6 months after the agreement
Plan viability analysis
Action 1		The human and material resources are available, being totally plausible of execution.
Action 2		All resources are available. Barrier: guarantee actions continuity after leaving the current residency group. Justification: action manager is the current dentist resident and the municipality has not received dentistry residents for two years, because this vacancy has not been filled in the selections. There is a high turnover of health professionals at the UAPS, as they are only hired, there are no effective positions. Possible solution: link the project management to the UAPS ACSs, because almost all of them are effective in the municipal job.
Action 3		There are no resources available Barrier: lack of financial fund for the purchase of equipment and hiring professionals. Justification: chronic financial problems, such as underfunding of the Unified Health System (SUS), insufficient allocation of budgetary and financial resources to fully comply with the constitutional principles of universal access, integrality and equity [⁷7 Funcia FR. Underfunding and federal budget of SUS: Preliminary references for additional resource allocation. Cienc Saude Colet. 2019;24(12):4405-15. http://dx.doi.org/10.1590/1413-812320182412.25892019 https://doi.org/10.1590/1413-81232018241... ]. Possible solution: agreement between civil servants (oral health team) and managers (UAPS coordinator, health secretary and municipal mayor) to seek the necessary resources.
TACTICAL-OPERATIONAL MOMENT
The tactical-operational moment, in turn, corresponds to the execution of actions under the management, monitoring and evaluation of the operations that make up the plan [⁶6 Teixeira CF (org.). Planejamento em saúde: conceitos, métodos e experiências. Salvador: EDUFBA; 2010.]. This part corresponds to the detailing of how it will be analyzed and determined whether the planned actions were effective. This effectiveness is based on the goal to be achieved, mentioned at the strategic moment of the plan.