A política de saúde bucal: experiência dos cirurgiões-dentistas, gestores e idosos.
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Data
2019-08-23
Autores
Rocha, Suelen Alves
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Universidade Estadual Paulista (Unesp)
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Introdução: A instituição de políticas públicas voltadas ao envelhecimento populacional constitui uma forma efetiva dos países ocidentais lidarem com a transição demográfica. No entanto, poucos países têm programas de saúde pública que possibilitam idosos acessarem cuidados de saúde bucal, por exemplo, sem barreiras financeiras. Apenas em 2004, a política pública de saúde bucal brasileira passou a ofertar cuidados de saúde bucal, de maneira universal e integral, no contexto do Sistema Único de Saúde (SUS). Assim, esta pesquisa pretende analisar a operacionalização da política de saúde bucal por meio das experiências de idosos com o acesso aos cuidados bucais a partir da Atenção Primária à Saúde, bem como dos cirurgiões-dentistas com a oferta deste cuidado e dos gestores com a implantação e consolidação desta política. Desta maneira, questiona-se: — Os idosos brasileiros conseguem acessar cuidados de saúde bucal no SUS? — Como a política nacional de saúde bucal projeta as ações de saúde bucal em nível local? Objetivo geral: Fazer uma análise da operacionalização da política de saúde bucal brasileira a partir da metassíntese das experiências dos cirurgiões-dentistas, idosos e gestores da política de saúde bucal. Objetivos específicos: (a) compreender o processo experiencial de idosos adscritos às Unidades de Saúde da Família (USFs), de cirurgiões-dentistas que os atendem, assim como gestores municipais e federais, envolvidos na operacionalização da política de saúde bucal brasileira; (b) propor modelos teóricos representativos de cada experiência e; (c) elaborar metassíntese a partir dos modelos teóricos emersos das experiências, resultando em metamodelo. Método: Esta pesquisa faz parte de um projeto maior que investiga o acesso aos cuidados primários de saúde no Sistema Único de Saúde por meio da análise da demanda espontânea. Trata-se de estudo qualitativo orientado pela Teoria Fundamentada nos Dados (TFD), na vertente Strauss e Corbin, tendo como referencial teórico a teoria do reconhecimento social de Axel Honneth. Os dados foram coletados por meio de entrevista não diretiva, gravada e transcrita na íntegra, com 34 atores, sendo: 16 cirurgiões-dentistas de USFs (grupo amostral 1), seis cirurgiões-dentistas em cargos de gestão da saúde bucal, sendo três em nível municipal (grupo amostral 2) e três federal (grupo amostral 3) e 12 idosos adscritos às USFs (grupo amostral 4), de um município do interior paulista. Resultados: Da análise das experiências dos grupos amostrais, emergiram quatro categorias centrais, respectivamente, a saber: “tentando alcançar a relevância social da odontologia na Atenção Primária à Saúde apoiado nos atores do cenário micropolítico”; “obtendo sucesso nos projetos de gestão da saúde bucal no município ao colocar o cirurgião-dentista em evidência”; “da satisfação com a concretização à frustração com a instabilidade do Brasil Sorridente: legitimidade social como componente interveniente na luta pela sustentabilidade da política”; “entre atratores e dissipadores do cuidado de saúde bucal ofertado na ESF”. Do realinhamento de componentes oriundos dos quatro modelos teóricos, por meio de recursos da TFD e da metassíntese, permitiu processo analítico que resultou na categoria central deste trabalho (metamodelo), intitulada: “idoso como coadjuvante na luta da odontologia pelo reconhecimento social da profissão”. Considerações finais: percebe-se pouco acesso efetivo de idosos aos cuidados de saúde bucal na Estratégia Saúde da Família (ESF). Tal experiência conduz idosos à busca de cuidados de saúde bucal no setor privado ou à resignação com sua condição de saúde. Enquanto cirurgiões-dentistas brasileiros demonstram algum potencial de agenciamento político. Encontramos lideranças da odontologia inseridas nos diversos cenários políticos, conseguindo inserir as pautas da categoria profissional na agenda política.
Introduction: To proactively enact public policies which address the ageing process is an effective way for Western countries to tackle the demographic transition. However, few countries have public health programs that enable older people to access oral health care, for example, without financial barriers. Only in 2004, the Brazilian oral health public policy started to offer universal and comprehensive oral healthcare in the Unified Health System (SUS). Thus, this research aims to analyze the oral health policy operationalization throughout the elderly’s experiences with oral health care access at the primary health care, the dentists’ experience in providing care, and the managers’ experience with the implementation and consolidation of this policy. Thus, it is questioned: - Can the Brazilian elderly access oral health care in the SUS? - How does the national oral health policy project oral health actions at the local level? General objective: To analyze the operationalization of the Brazilian oral health policy based on the meta-synthesis of the experiences of dentists, elderly and oral health policy managers. Specific objectives: (a) understand the experience of elderly people attended by the Family Health Units (FHUs), the dentists’ experience in assisting them, and the municipal and federal managers’ experience with the Brazilian oral health policy; (b) propose theoretical models of each experience and; (c) elaborate metasynthesis from the theoretical models emerging, resulting in the metamodel. Method: This research is part of a larger project that investigates access to primary health care in the SUS through the analysis of unscheduled care. This is a qualitative study guided by the Grounded Theory (GT), according to Strauss and Corbin approach, using Axel Honneth's theory of social recognition as a theoretical reference. Data were collected through a non-directive interview, recorded and transcribed in full, with 34 actors: 16 dentists from FHUs (sample group 1), six dentists in oral health management positions, being three in the county level (sample group 2) and three federal levels (sample group 3) and 12 elderly people enrolled in the FHUs (sample group 4), from a town in the state of São Paulo, Brazil. Results: from the analysis of the experiences of the sample groups, four core categories emerged, respectively: “trying to reach the social relevance of dentistry in primary health care based on the actors of the micropolitical scenario”; “Succeeding in oral health management projects in the municipality by putting the dentist in evidence”; “From satisfaction with the achievement to frustration with the instability of Brasil Sorridente: social legitimacy as an intervening component in the struggle for the sustainability of politics”; “Between attractors and dissipators of dental care offered at the Family Health Strategy”. The realignment of components from the four theoretical models, using GT and meta-synthesis resources, allowed for an analytical process that resulted in the core category of this research (metamodel), entitled: “elderly as an aid in the fight of dentistry for the social recognition of the profession”. Final considerations: elderly people have little effective access to oral health care in the Family Health Strategy. This experience leads the elderly to seek dental care at the private sector or to settle for their poor oral health status. However, Brazilian dentists have potential political agency. We found leaders of dentistry inserted in the various political scenarios, managing to put their interesting on the political agenda
Introduction: To proactively enact public policies which address the ageing process is an effective way for Western countries to tackle the demographic transition. However, few countries have public health programs that enable older people to access oral health care, for example, without financial barriers. Only in 2004, the Brazilian oral health public policy started to offer universal and comprehensive oral healthcare in the Unified Health System (SUS). Thus, this research aims to analyze the oral health policy operationalization throughout the elderly’s experiences with oral health care access at the primary health care, the dentists’ experience in providing care, and the managers’ experience with the implementation and consolidation of this policy. Thus, it is questioned: - Can the Brazilian elderly access oral health care in the SUS? - How does the national oral health policy project oral health actions at the local level? General objective: To analyze the operationalization of the Brazilian oral health policy based on the meta-synthesis of the experiences of dentists, elderly and oral health policy managers. Specific objectives: (a) understand the experience of elderly people attended by the Family Health Units (FHUs), the dentists’ experience in assisting them, and the municipal and federal managers’ experience with the Brazilian oral health policy; (b) propose theoretical models of each experience and; (c) elaborate metasynthesis from the theoretical models emerging, resulting in the metamodel. Method: This research is part of a larger project that investigates access to primary health care in the SUS through the analysis of unscheduled care. This is a qualitative study guided by the Grounded Theory (GT), according to Strauss and Corbin approach, using Axel Honneth's theory of social recognition as a theoretical reference. Data were collected through a non-directive interview, recorded and transcribed in full, with 34 actors: 16 dentists from FHUs (sample group 1), six dentists in oral health management positions, being three in the county level (sample group 2) and three federal levels (sample group 3) and 12 elderly people enrolled in the FHUs (sample group 4), from a town in the state of São Paulo, Brazil. Results: from the analysis of the experiences of the sample groups, four core categories emerged, respectively: “trying to reach the social relevance of dentistry in primary health care based on the actors of the micropolitical scenario”; “Succeeding in oral health management projects in the municipality by putting the dentist in evidence”; “From satisfaction with the achievement to frustration with the instability of Brasil Sorridente: social legitimacy as an intervening component in the struggle for the sustainability of politics”; “Between attractors and dissipators of dental care offered at the Family Health Strategy”. The realignment of components from the four theoretical models, using GT and meta-synthesis resources, allowed for an analytical process that resulted in the core category of this research (metamodel), entitled: “elderly as an aid in the fight of dentistry for the social recognition of the profession”. Final considerations: elderly people have little effective access to oral health care in the Family Health Strategy. This experience leads the elderly to seek dental care at the private sector or to settle for their poor oral health status. However, Brazilian dentists have potential political agency. We found leaders of dentistry inserted in the various political scenarios, managing to put their interesting on the political agenda
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Palavras-chave
política de saúde, saúde bucal, Cirurgião-dentista, idoso, atenção primária à saúde, Oral health policies, Oral health, Elderly, Dentists, Primary health care