Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Katz, N.; Roman, R.; Rados, D.V.; Oliveira EB, D.; Schmitz CA, A.; Gonçalves, M.R.; Umpierre, R.N. Access and regulation of specialized care in Rio Grande do Sul: The RegulaSUS strategy of Telessaúde RS-UFRGS. Cien. Saude Colet. 2020, 25, 1389–1400. [Google Scholar] [CrossRef] [PubMed]
- Arantes, L.J.; Shimizu, H.E.; Merchán-Hamann, E. The benefits and challenges of the family health strategy in Brazilian primary health care: A literature review. Cienc. Saude Colet. 2016, 21, 1499–1509. [Google Scholar] [CrossRef] [PubMed]
- Martins, R.C.; Reis, C.M.R.d.; Matta Machado, A.T.G.d.; Amaral, J.H.L.d.; Werneck, M.A.F.; Abreu, M.H.N.G.D. Relationship between Primary and Secondary Dental Care in Public Health Services in Brazil. PLoS ONE 2016, 11, e0164986. [Google Scholar] [CrossRef] [PubMed]
- Cardozo, I.; da Silva, V.C.; Perdoncini, N.N.; Torres-Pereira, C.C. Telehealth in Oral Medicine: Report of an experience from public health care in a southern Brazilian state. Braz. Oral Res. 2022, 36, 1–7. [Google Scholar] [CrossRef]
- Alabdullah, J.H.; Daniel, S.J. A Systematic Review on the Validity of Teledentistry. Telemed. J. E Health 2018, 24, 639–648. [Google Scholar] [CrossRef] [PubMed]
- Pachito, D.V.; Azeredo-da-Silva, A.L.F.; Oliveira, P.R.B.P.; Bagattini, Â.M.; Basso, J.; Gehres, L.G.; Mallmann, E.D.B.; Rodrigues, A.S.; Riera, R.; Gadenz, S.D.; et al. Telehealth strategies to support referral management to secondary care in Brazil: A cost-effectiveness analysis. Value Health Reg. Issues 2022, 31, 74–80. [Google Scholar] [CrossRef]
- Pachito, D.V.; de Azeredo-da AL, F.; de Oliveira PR, B.; Bagattini, Â.M.; Basso, J.; Gehres, L.G.; Gadenz, S.D. Telehealth to support referral management in a universal health system: A before-and-after study. BMC Health Serv. Res. 2021, 21, 1012. [Google Scholar]
- Sperling, S.; Andretta, C.R.D.L.; Basso, J.; Batista, C.E.A.; Borysow, I.D.C.; Cabral, F.C.; Filho, E.D.D.C.; Costa, L.A.V.; Gehres, L.G.; Kim, K.Y.; et al. Telehealth for Supporting Referrals to Specialized Care During COVID-19. Telemed. J. E Health 2022, 28, 544–550. [Google Scholar] [CrossRef]
- Ghai, S. Teledentistry during COVID-19 pandemic. Diabetes Metab. Syndr. 2020, 14, 933–935. [Google Scholar] [CrossRef]
- Technical Note nº 50/2015 Homepage. Available online: http://189.28.128.100/dab/docs/portaldab/notas_tecnicas/Nota_Tecnica_Diretrizes_Telessaude.pdf (accessed on 21 November 2016).
- Brito, T.D.D.L.V.; Baptista, R.S.; Lopes, P.R.D.L.; Taylor, A.; Haddad, A.E.; Messina, L.A.; Pisa, I.T. Collaboration Between Medical Professionals: Special Interest Groups in the Brazilian Telemedicine University Network (RUTE). Telemed. J. E Health 2019, 25, 902–910. [Google Scholar]
- Resolution nº 226, of June 4, 2020. Provides for the Practice of Dentistry, Mediated by Technologies, and Provides Other Measures Homepage. Available online: http://sistemas.cfo.org.br/visualizar/atos/RESOLUÇÃO/SEC/2020/226 (accessed on 11 March 2023).
- Costa, C.B.; Peralta, F.D.; Mello, A.L.S.F. How has teledentistry been applied in public dental health services? An integrative review. Telemed. J. E Health 2020, 26, 945–954. [Google Scholar] [CrossRef]
- Harzheim, E.; Gonçalves, M.R.; Umpierre, R.N.; Siqueira, A.C.D.S.; Katz, N.; Agostinho, M.R.; Oliveira, E.B.; Basso, J.; Roman, R.; Moro, R.G.D.; et al. Telehealth in Rio Grande do Sul, Brazil: Bridging the gaps. Telemed. J. E Health 2016, 22, 938–944. [Google Scholar] [CrossRef]
- de Melo, M.D.C.B.; Nunes, M.V.; Resende, R.F.; Figueiredo, R.R.; Ruas, S.S.M.; Santos, A.D.F.D.; Alves, H.J.; de Aguiar, R.A.T. Belo Horizonte telehealth: Incorporation of teleconsultations in a health primary care system. Telemed. J. E Health 2018, 24, 631–638. [Google Scholar] [CrossRef]
- Bavaresco, C.S.; Hauser, L.; Haddad, A.E.; Harzheim, E. Impact of teleconsultations on the conduct of oral health teams in the Telehealth Brazil Networks Programme. Braz. Oral Res. 2020, 34, e011. [Google Scholar] [CrossRef] [PubMed]
- Monitoring and Evaluation System of the Telehealth Results. Available online: http://smart.telessaude.ufrm.br (accessed on 11 March 2023).
- Telehealth Brasil Networks Model of Data Interoperability Homepage. Available online: https://smart.telessaude.ufrn.br/webapp/api_docs/ (accessed on 20 February 2021).
- Human Development in Brazil Atlas Homepage. Available online: https://atlasbrasil.org.br/ (accessed on 22 October 2020).
- E-manager Information and Management of Primary Health Care. Oral Health Coverage. Available online: https://egestorab.saude.gov.br/paginas/acessoPublico/relatorios/relHistoricoCobertura.xhtml (accessed on 17 February 2021).
- Cities Served with Dental Specialties Centers. Available online: https://egestorab.saude.gov.br/image/?file=20200814_N_SituacaosimplificadaCEO_3079560485832398423.pdf (accessed on 17 February 2021).
- Data SUS. Tabnet. Available online: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/ (accessed on 22 March 2022).
- Smueli, G. To explain or to predict? Stat. Sci. 2010, 25, 289–310. [Google Scholar]
- Natal, K.H.; Machado, T.G.; Bracco, F.; Lemos, L.I.; Vigano, M.E.; Machado, G.M.; Yampa-Vargas, J.D.; Raggio, D.P.; Mendes, F.M.; Imparato, J.C.P.; et al. Using information and communication technologies (ICTs) to solve the repressed demand for primary dental care in the Brazilian Unified Health System due to the COVID-19 pandemic: A randomized controlled study protocol nested with a before-and-after study including economic analysis. BMC Oral Health 2022, 22, 112. [Google Scholar]
- Sarti, T.D.; Almeida, A.P.S.C. Incorporation of telehealth in primary healthcare and associated factors in Brazil. Cad. Saúde Pública 2022, 38, 1–15. [Google Scholar]
- Gurgel-Juarez, N.; Torres-Pereira, C.; Haddad, A.E.; Sheehy, L.; Finestone, H.; Mallet, K.; Wiseman, M.; Hour, K.; Flowers, H.L. Accuracy and effectiveness of teledentistry: A systematic review of systematic reviews. Evid. Based Dent. 2022, 8, 1–8. [Google Scholar] [CrossRef]
- Dos Santos, A.D.F.; Mata-Machado, A.T.G.D.; Melo, M.D.C.B.D.; Fonseca Sobrinho, D.; Araújo, L.L.; Silva, É.A.; Rocha, H.A.D. Implementation of Telehealth resources in Primary Care in Brazil and its association with quality of care. Telemed. J. E Health 2019, 25, 996–1004. [Google Scholar] [CrossRef] [PubMed]
- Olayiwola, J.N.; Potapov, A.; Gordon, A.; Jurado, J.; Magana, C.; Knox, M.; Tuot, D. Electronic consultation impact from the primary care clinician perspective: Outcomes from a national sample. J. Telemed. Telecare 2018, 25, 493–498. [Google Scholar] [CrossRef]
- Paixão, L.C.; Costa, V.A.; Ferreira, E.F.E.; Sobrinho, A.P.R.; Martins, R.D.C. Analysis of the asynchronous dental teleconsulting of Telehealth Brazil Networks in Minas Gerais. Braz. Oral Res. 2018, 32, 1–9. [Google Scholar] [CrossRef]
- Maqsood, A.; Sadiq, M.S.K.; Mirza, D.; Ahmed, N.; Lal, A.; Alam, M.K.; Bin Halim, M.S. The Teledentistry, Impact, Current Trends, and Application in Dentistry: A Global Study. BioMed Res. Int. 2021, 2021, 5437237. [Google Scholar] [CrossRef]
- Haluza, D.; Wernhart, A. Does gender matter? Exploring perceptions regarding health technologies among employees and students at a medical university. Int. J. Med. Inform. 2019, 130, 103948. [Google Scholar] [CrossRef] [PubMed]
- National Health Survey 2019. Information about Households, Access, and Use of Health Services. Available online: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101748.pdf (accessed on 16 June 2022).
- Patrão, A.L.; Almeida, M.C.C.; Alvim, S.; Chor, D.; Aquino, E.M. Health behaviour-related indicator of lifestyle: Application in the ELSA-Brasil study. Glob. Health Promot. 2019, 26, 62–69. [Google Scholar] [CrossRef]
- Junqueira, S.R.; Pannuti, C.M.; Rode, S.M. Oral health in Brazil Part I: Public oral health policies. Braz. Oral Res. 2008, 22, 8–17. [Google Scholar] [CrossRef] [PubMed]
- Reis, C.M.R.; Matta-Machado, A.T.G.; Amaral, J.H.L.; Mambrini, J.V.D.M.; Werneck, M.A.F.; De Abreu, M.H.N.G. Understanding oral health care team performance in primary care: A mixed-method study. PLoS ONE 2019, 14, e0217738. [Google Scholar] [CrossRef] [PubMed]
- Scalzo, M.T.A.; Abreu, M.H.N.G.; Matta-Machado, A.T.G.; Martins, R.C. Oral health in Brazil: What were the dental procedures performed in Primary Health Care? PLoS ONE 2022, 17, e0263257. [Google Scholar] [CrossRef]
- da Rocha Mendes, S.; de Castro Martins, R.; de Melo Mambrini, J.V.; Matta-Machado AT, G.; Mattos-Savage, G.C.; Gallagher, J.E.; de Abreu, M.H.N.G. The influence of dentists’ profile and health work management in the performance of Brazilian dental teams. Biomed. Res. Int. 2021, 2021, 8843928. [Google Scholar] [CrossRef]
Variable | Description |
---|---|
Level 1—Individual 1 | |
Sex | Male–female |
Dental specialty | FHS a |
General dental practitioner | |
Specialist | |
Dentistry field | General dentistry b |
Semiology c/pharmacology d/oral medicine e | |
Services f | |
Health promotion and prevention g | |
Level 2—Contextual 2 | |
mHDI | Municipal Human Development Index (0–1) |
OHT h in PHC i coverage | Annual mean percentage (%) of the population covered by (OHT)/PHC |
DSC j coverage | Rate of DSC/1,000,000 inhabitants |
Illiteracy rate | Illiteracy rate of each municipality |
Gini index | Gini index (0–1) |
Longevity | Life expectancy at birth |
Per capita income | Per capita income of each municipality |
Variable | N | % |
---|---|---|
Dependent variable | ||
Teleconsulting sessions avoided patient referral to other care levels | ||
Yes | 859 | 65.1 |
No | 460 | 34.9 |
Independent variables (individual level) | ||
Sex | ||
Female | 861 | 65.3 |
Male | 458 | 34.7 |
Dentist specialist | ||
FHS | 631 | 47.8 |
General dental practitioner | 577 | 43.8 |
Specialist | 111 | 8.4 |
Dentistry field | ||
Semiology/pharmacology/stomatology | 603 | 45.7 |
General dentistry | 535 | 40.6 |
Services | 96 | 7.3 |
Health promotion and prevention | 85 | 6.4 |
Variable * | p-Value | P25% | P50% | P75% |
---|---|---|---|---|
mHDI | 0.000 | 0.602 | 0.675 | 0.721 |
OHT/PHC coverage | 0.000 | 41.550 | 76.520 | 100.000 |
DSC | 0.000 | 0.000 | 0.000 | 0.000 |
Illiteracy rate | 0.000 | 7.900 | 12.300 | 21.900 |
Gini index | 0.012 | 0.450 | 0.500 | 0.540 |
Longevity | 0.001 | 71.420 | 73.670 | 75.010 |
Per capita income | 0.000 | 290.990 | 493.590 | 674.120 |
Random Effect | Standard Deviation | Variance Component | df | Chi-Square | p-Value |
---|---|---|---|---|---|
Intercept, U0 | 1.61533 | 2.60929 | 277 | 655.89 | 0.000 * |
Variable | Avoided Referral (%) | Unadjusted OR * | 95% CI | p-Value | Adjusted OR * | 95% CI | p-Value |
---|---|---|---|---|---|---|---|
Individual level | |||||||
Sex | |||||||
Male | 51.1 | 1 | 1 | ||||
Female | 72.6 | 1.74 | 0.95–3.18 | 0.073 | 1.84 | 0.99–3.44 | 0.055 |
Dentist specialist | |||||||
FHS | 68.6 | 1 | 1 | ||||
General dental practitioner | 61.0 | 1.05 | 0.57–1.94 | 0.870 | 0.98 | 0.53–1.82 | 0.949 |
Specialist | 66.7 | 1.13 | 0.41–3.09 | 0.813 | 1.18 | 0.43–3.29 | 0.745 |
Dentistry field | |||||||
General dentistry | 73.8 | 1 | 1 | ||||
Semiology/pharmacology/stomatology | 30.0 | 0.82 | 0.50–1.32 | 0.407 | 0.78 | 0.48–1.27 | 0.318 |
Services | 56.2 | 0.77 | 0.36–1.64 | 0.496 | 0.74 | 0.34–1.60 | 0.445 |
Health promotion and prevention | 40.0 | 0.85 | 0.34–2.13 | 0.722 | 0.78 | 0.31–1.98 | 0.606 |
Contextual level | |||||||
mHDI | 6.78 | 0.14–333.33 | 0.332 | 0.000258 | 0.00–0.04 | 0.159 | |
OHT/PHC coverage | 1.01 | 1.00–1.02 | 0.016 | 1.01 | 1.00–1.02 | 0.020 | |
DSC coverage | 0.99 | 0.98–1.01 | 0.424 | 0.99 | 0.98–1.01 | 0.349 | |
Illiteracy rate | 0.99 | 0.96–1.02 | 0.524 | 1.00 | 0.96–1.03 | 0.928 | |
Gini index | 0.09 | 0.00–5.68 | 0.257 | 0.42 | 0.00–58.8 | 0.729 | |
Longevity | 1.03 | 0.92–1.16 | 0.550 | 0.96 | 0.78–1.18 | 0.710 | |
Per capita | 1.00 | 0.99–1.00 | 0.816 | 1.00 | 0.99–1.00 | 0.197 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Paixão, L.C.; Abreu, M.H.N.G.; Ribeiro-Sobrinho, A.P.; Martins, R.C. Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil. Int. J. Environ. Res. Public Health 2023, 20, 5104. https://doi.org/10.3390/ijerph20065104
Paixão LC, Abreu MHNG, Ribeiro-Sobrinho AP, Martins RC. Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil. International Journal of Environmental Research and Public Health. 2023; 20(6):5104. https://doi.org/10.3390/ijerph20065104
Chicago/Turabian StylePaixão, Lígia C., Mauro Henrique N. G. Abreu, Antônio P. Ribeiro-Sobrinho, and Renata C. Martins. 2023. "Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil" International Journal of Environmental Research and Public Health 20, no. 6: 5104. https://doi.org/10.3390/ijerph20065104
APA StylePaixão, L. C., Abreu, M. H. N. G., Ribeiro-Sobrinho, A. P., & Martins, R. C. (2023). Factors Associated with Avoiding Referrals by Dental Teleconsulting Sessions in Brazil. International Journal of Environmental Research and Public Health, 20(6), 5104. https://doi.org/10.3390/ijerph20065104