Acessibilidade e saúde bucal: itinerários terapêuticos de usuários do Sistema Único de Saúde (SUS) do interior do estado de São Paulo (SP)

Abstract

The present study aimed to investigate how the accessibility to oral health services occurs in two municipalities in the interior of the São Paulo State (SP), using the therapeutic itineraries (called as ITs) as theoretical-methodological reference. Municipalities of Ibaté and São Carlos were chosen, since both are part of the same Regional Management Collegiate (called as CGR Coração), being that, in the process of health regionalization, the Center of Dental Specialties of São Carlos city is a reference for the Ibaté city. Twelve health units participated of this study, being six Basic Health Units (called as UBS) and six Family Health Units (called as USF). Twelve users were interviewed. The data collection was made from a semi-structured interview, a field diary and a non-participant observation. Users of different age groups were interviewed, and in all ITs, the trigger for care search was the perception of an installed problem. However, there was a variation in this trigger according to age, i.e., the dental pain was the trigger for the younger persons, whereas the need for prosthesis was the trigger for middle-aged adults and elderly persons. Five users had systemic diseases: one renal transplant, one with Parkinson’s disease and three with diabetes mellitus and hypertension. In addition, two users were pregnant. No interviewed user correlated their general health with oral health, even with all the efforts of Dentistry to prove the influence of oral diseases on the systemic diseases. The accessibility barriers found in this study were related to those of an organizational, economic and sociocultural nature. The obstacles originated in the entrance of the health services were the scheduling of the first dental consultation and emergency care, both were through the spontaneous demand attendance with the criterion of order of arrival in all units evaluated and with small differences between UBS and USF. On the other hand, the post-entry obstacles were the consultation scheduling in the dental prosthesis specialty, the difficulty in returning to the treatment after a lack and specialized scheduling only in a private clinic. The economic barriers referred to the financial difficulty to access the treatments in private clinics and the impossibility to perform the treatment in the health unit to avoid losing the work day, whereas the sociocultural barriers consisted in the understanding of the public health system as a place for the treatment of people who do not have money to pay for the private, as a favor of the State and, therefore, as a system that cannot receive complaints and improvements. Thus, despite the considerable increase in the supply of oral health services provided by National Oral Health Policy in order for the population has accessibility to these services, it is necessary the reorganization of the work processes developed in the health units so that the integrality to health is the north of oral health practices, besides of the need for humanized care.