Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2003.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0039 ; please contact computer services.

Thesis (M.P.H.)--University of Michigan, 1945.

Thesis (M.S.P.H.)--University of Michigan, 1942.

Thesis (M.P.H.)--University of Michigan, 1945.

Made available in DSpace on 2014-06-11T19:33:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-12-12Bitstream added on 2014-06-13T19:22:57Z : No. of bitstreams: 1 diniz_dg_dr_araca.pdf: 1702376 bytes, checksum: 58ba4398f4e8857374b34b777f9a8e9b (MD5) / O objetivo dessa pesquisa-ação foi propor um modelo de acolhimento odontológico (ACO) na estratégia de saúde da família e verificar, na prática, sua utilização como ferramenta facilitadora na organização do acesso aos serviços de saúde bucal. O ACO foi elaborado com foco na reorganização da atenção ao público da demanda espontânea, visando o atendimento de todos os usuários, com o estabelecimento de fluxos e protocolos nos processos de trabalho e de parâmetros de continuidade de tratamento aos pacientes. Num período de 12 meses antes e após a implantação do ACO, foram avaliadas as variáveis referentes às características dos atendimentos realizados, ao perfil da população atendida e à produtividade das equipes de saúde bucal. Os resultados demonstraram que, os atendimentos no ACO, foram, na sua maioria, de usuários que nunca haviam sido atendidos antes na unidade. Os adultos foram a faixa etária predominante. A dor dentária foi a queixa mais citada, sendo a cárie, o principal motivo diagnosticado. Observou-se um agravamento nos riscos de saúde bucal na população atendida nas consultas programadas após a implantação do ACO, em virtude da facilitação do acesso e das medidas de continuidade adotadas. A implementação de fluxos e protocolos possibilitou o aumento da produtividade das equipes. Concluiu-se que o modelo proposto atuou como uma importante porta para a organização do acesso, permitindo a identificação de indivíduos e grupos com maior vulnerabilidade, o que possibilitou um aperfeiçoamento no planejamento, na organização e na implantação de estratégias imediatas de ações em saúde bucal, com tendência ao desenvolvimento de um trabalho mais equânime e universal na localidade / The aim of this action research was to propose a model of dental user embracement (DUE) in the family health strategy and verify, in practice, its use as a tool to help the organization of access to oral health services. The DUE was based on the reorganization of the public's spontaneous demand to meet all users, with establishments fluxes and protocols in the work process and continuity parameters of treatment. In a 12-month period before and after the implementation of the DUE, the variables were assessed regarding the characteristics of dental care, the profile of the population attended and the productivity of oral health teams. The results demonstrated that the DUE were in attendance, mostly from users who never receive dental care on the unit. The adults were the main age group. The tooth pain was the most often cited complaint being, the caries, the main reason diagnosed. It was observed a worsening in the risk of oral health in the population attended in the consultations scheduled after the implementation of DUE, because of easier access and continuity of the measures adopted. The implementation of fluxes and protocols improved the productivity of teams. It was concluded that the proposed model has served as an important gateway to the organization of access, allowing the identification of people and groups with greater vulnerability, allowing an improvement in the planning, organization and implementation of strategies for immediate actions on oral health with tendency to the development of a work more equitable and universal in locality

Orientador: Suzely Adas Saliba Moimaz / Banca: Rogério Nogueira de Oliveira / Banca: Luís Carlos Cavalcante Galvão / Resumo: O Sistema de Auditoria no setor saúde é fundamental, pois permite a avaliação da veracidade das informações e a resolubilidade da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal do município de Aquidauana (MS); fazer o levantamento das principais justificativas de glosas e das perdas de produção; analisar as atividades desenvolvidas pelas equipes da Estratégia da Saúde da Família. É um estudo epidemiológico de série histórica retrospectiva, com abordagem quantitativa, entre os anos de 2001 a 2010. Foi realizada análise documental e revisão bibliográfica sobre os sistemas de auditoria e o papel do auditor no serviço odontológico. Para o levantamento dos dados de produção, perdas, justificativas de glosas e cumprimento de metas foram utilizadas respectivamente, o sistema de informação do DATASUS, relatórios realizados pelo Sistema Municipal de Auditoria do município de Aquidauana (MS), relatórios dos indicadores propostos pelos Decretos nº 11.684/2004 e nº 12.005/2005 da Secretaria Estadual de Saúde do Mato Grosso do Sul que estabelece mensalmente o mínimo de 10 visitas domiciliares, 26 tratamentos completados e uma atividade educativa. Os resultados mostraram que a atuação da auditoria é abrangente no gerenciamento do sistema, consistindo no controle, avaliação, supervisão e orientação, bem como na garantia da participação social e acesso aos serviços. Neste período foram apresentados 921.300 procedimentos odontológicos; sendo 223.226 (24,2%) procedimentos individuais e 698.074 (75,8%) coletivos. Ocorreram 23.881 glosas (2,6%), sendo 10.158 (42,5%) nos procedimentos coletivos e 13.723 (57,5%) nos individuais. Constatou-se que a ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Auditing system in public health is furthermost important, as it permits the evaluation of veracity of information and to access the accuracy in delivering services, assuming a model of adequate attention. The research objectives were to analyze auditing activities in oral health from the Single Health System within the municipality of Aquidauana (MS); to find the main justifications for glosses and losses in production; and to analyze activities developed by the strategic family health units. This is an epidemiological study of a retrospective historical series, with a quantitative approach, from 2001 to 2010, with a documental analysis and literature review about the auditing systems and the role of the auditor in odontological services. To compile the data from production, losses in procedures, and justifications for glosses as well as the achievement of targets, the database DATASUS was used, reports from the municipal system of auditing in the municipality of Aquidauana (MS) and reports and indicators from decrees 11,684/2004 and 12,005/2005 from the Health State Office of Mato Grosso do Sul- which establishes a minimum of 10 home visits monthly, 26 treatments completed and one education activity. Results show a broad range of activities from the auditing system in the system management, including activities for control, evaluation, supervision, orientation, and guarantee for social engagement and access to services. In this period there were 921,300 odontological procedures; from which 223,226 (24.2%) were individual procedures and 698,074 (75.8%) were collective procedures. There were 23,881 glosses (2.6%), from which 10,158 (42.5%) happened in collective procedures and 13,723 (57.5%) happened in individual procedures. It was found that the most frequent cause for glosses in individual procedures was the repetition in procedure to the ... (Complete abstract click electronic access below) / Mestre

Orientador: Artênio José Ísper Garbin / Banca: Mônica da Costa Serra / Banca: Renato Herman Sundfeld / Banca: Antonio Carlos Pereira / Banca: Arsenio Sales Peres / Resumo: O objetivo dessa pesquisa-ação foi propor um modelo de acolhimento odontológico (ACO) na estratégia de saúde da família e verificar, na prática, sua utilização como ferramenta facilitadora na organização do acesso aos serviços de saúde bucal. O ACO foi elaborado com foco na reorganização da atenção ao público da demanda espontânea, visando o atendimento de todos os usuários, com o estabelecimento de fluxos e protocolos nos processos de trabalho e de parâmetros de continuidade de tratamento aos pacientes. Num período de 12 meses antes e após a implantação do ACO, foram avaliadas as variáveis referentes às características dos atendimentos realizados, ao perfil da população atendida e à produtividade das equipes de saúde bucal. Os resultados demonstraram que, os atendimentos no ACO, foram, na sua maioria, de usuários que nunca haviam sido atendidos antes na unidade. Os adultos foram a faixa etária predominante. A dor dentária foi a queixa mais citada, sendo a cárie, o principal motivo diagnosticado. Observou-se um agravamento nos riscos de saúde bucal na população atendida nas consultas programadas após a implantação do ACO, em virtude da facilitação do acesso e das medidas de continuidade adotadas. A implementação de fluxos e protocolos possibilitou o aumento da produtividade das equipes. Concluiu-se que o modelo proposto atuou como uma importante porta para a organização do acesso, permitindo a identificação de indivíduos e grupos com maior vulnerabilidade, o que possibilitou um aperfeiçoamento no planejamento, na organização e na implantação de estratégias imediatas de ações em saúde bucal, com tendência ao desenvolvimento de um trabalho mais equânime e universal na localidade / Abstract: The aim of this action research was to propose a model of dental user embracement (DUE) in the family health strategy and verify, in practice, its use as a tool to help the organization of access to oral health services. The DUE was based on the reorganization of the public's spontaneous demand to meet all users, with establishments fluxes and protocols in the work process and continuity parameters of treatment. In a 12-month period before and after the implementation of the DUE, the variables were assessed regarding the characteristics of dental care, the profile of the population attended and the productivity of oral health teams. The results demonstrated that the DUE were in attendance, mostly from users who never receive dental care on the unit. The adults were the main age group. The tooth pain was the most often cited complaint being, the caries, the main reason diagnosed. It was observed a worsening in the risk of oral health in the population attended in the consultations scheduled after the implementation of DUE, because of easier access and continuity of the measures adopted. The implementation of fluxes and protocols improved the productivity of teams. It was concluded that the proposed model has served as an important gateway to the organization of access, allowing the identification of people and groups with greater vulnerability, allowing an improvement in the planning, organization and implementation of strategies for immediate actions on oral health with tendency to the development of a work more equitable and universal in locality / Doutor

Previous studies suggest that Medicaid-enrolled children have difficulties accessing dental care, which can lead to untreated dental disease, poor oral health, and compromised overall health status. While Medicaid-enrolled children with a chronic condition (CC) encounter additional barriers to dental care, most relevant studies on dental utilization fail to adopt risk adjustment methods. As such, the impact of CC status and CC severity on access to dental care for Medicaid-enrolled children is poorly understood. The main objectives of this dissertation were to: 1) compare dental utilization for Medicaid-enrolled children with and without a CC; 2) assess the relationship between CC severity and dental utilization; and 3) identify the other factors associated with dental utilization. The 3M Clinical Risk Grouping (CRG) Methods were applied to enrollee-level data from the Iowa Medicaid Program (2003-2008) to identify children with and without a CC and to classify children with a CC into a CC severity level. Three outcome measures were developed: 1) access to an annual dental visit; 2) use of dental services under general anesthesia (GA); and 3) time to the first dental visit after initial enrollment into the Medicaid program. We used multiple variable logistic regression models and survival analytic techniques to test our study hypotheses. Compared to Medicaid-enrolled children without a CC, those with a CC were more likely to have had an annual dental visit and earlier first dental visits. Having a CC was an important determinant of dental utilization under GA for older but not for younger Medicaid-enrolled children. In terms of CC severity, Medicaid-enrolled children with more severe CCs were less likely to have had an annual dental visit and more likely to have utilized dental services under GA. CC severity was not associated with the rate at which the first dental visit took place. Not residing in a dental Health Professional Shortage Area, previous use of dental care, and previous utilization of primary medical care were all positively associated with dental utilization. Identifying and understanding the determinants of access to dental care is an important first step in developing clinical interventions and policies aimed at improving access to dental care for all Medicaid-enrolled children. Future work should focus on identifying the socio-behavioral determinants of as well as the clinical outcomes associated with access to dental services for vulnerable children.

Background / Objective: Children under the age of 5 years bear a disproportionate burden of oral disease. The aim of this study is to investigate how child, family, and community determinants impact dental care utilization, and parental report of child’s oral health. Methods: Data for this study came from the 2011/2012 National Survey of Children’s Health for children aged 1 to 5 years old. Dependent variables evaluated were if the child had an oral health problem, been to a dentist in the past year, and parents description of the child’s teeth. Independent variables were selected from child, family, and community levels. Binary logistic methods were applied to each outcome and predictor variable. Stepwise logistic regression models were constructed for child, family, and community variables. Additionally the mediating effect of oral health services utilization in the association between child, family and community factors and parental perception of child’s oral health was evaluated. National results and Health Resource Service Area (HRSA) region IV results were compared. Results: In the national (n=24,875) and HRSA region IV sample (n=4,017) 9.7% and 10.2% of caregivers, reported that the child had an oral health problem in the past 12 months. Fewer than half (46.7%) of caregivers reported that their child had visited a dentist in the past 12 months. Absence of neighborhood cohesion, neighborhood amenities, and residence in metropolitan statistical area all had positive significant effects on children seeing a dentist. There was a mediating effect by utilization of oral health services between child with special health care needs (p=0.005), number of children (p=0.045) and adults (p=0.046) in the household, and tobacco use (p=0.018) and parents perception of oral health in the HRSA region IV population. Conclusion: This study identified several factors as correlates of poor oral health outcomes. Our results expand our knowledge of early childhood oral health by studying how oral health is impacted not only by child factors but also the family and community at large. Our results begin identifying the unique constellation of risk factors that contribute to early childhood oral health.