Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review

Silva, Renata Marques da; Peres, Ana Carolina Oliveira; Carcereri, Daniela Lemos

doi:10.1590/1413-81232020256.15992018

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REVIEW • Ciênc. saúde coletiva 25 (6) • June 2020 • https://doi.org/10.1590/1413-81232020256.15992018 linkcopy

Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review

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This is an integrative review that aimed to analyze the performance of the oral health team in home care within the Family Health Strategy, after the publication of the National Oral Health Policy Guidelines. Databases PubMed, Lilacs and SciELO were used in the 2004-2018 period. The selected papers (n=17) were organized in Excel sheet with data: author, year of publication, title, objectives, publishing journal, study location, type of study and thematic category. Two categories emerged from the thematic analysis: “Oral health practices in the household context and the work process of the oral health team” (n=11) and “Instruments for the management and evaluation of home care by the oral health team” (n=6). The scientific production showed low frequency of home visits, lack of prioritization and systematization of home care actions and weak interaction with the family health team. The home care protocols and instruments for the prioritization of home visits indicate the potential to overcome the clinical approach restricted to the dental office. Fourteen years into the publication of the National Oral Health Policy guidelines, the household is a territory to be conquered by the oral health team.

Key words
Oral health; Home care; Family health

Author (s)/Year of publication	Title	Journal	Type and place of study	Main evidence of studies
Araújo e Dimenstein (2006)¹⁸	Estrutura e organização do trabalho do CD no PSF de municípios do Rio Grande do Norte (RN).	Ciência & Saúde Coletiva	Qualitative/RN	HVs were poorly executed, without prioritization according to the risk of families, and were a reproduction of traditional practices, fragmented and isolated in the DS work process.
Vilarinho et al. (2007)²¹	Perfil dos cirurgiões-dentistas integrantes do Programa Saúde da Família em Teresina (PI).	Revista Odonto Ciência	Quantitative/PI	70.8% of the DS performed scheduled HVs through the ACS and/or the ESB, and the HV was an instrument for the new dynamics of the ESF. The main challenge for model change is the high demand for clinical care.
Chaves e Silva (2007)²⁰	As práticas profissionais no campo público de atenção à saúde bucal: o caso de dois municípios da Bahia	Ciência & Saúde Coletiva	Qualitative/BA	In practice, the laws of the private subfield predominate individual action restricted to the practice. Only 1 CD reported performing RV in its typical week. Lack of consolidation of the link between professional and users of the service.
Barbosa et al. (2007)¹⁹	Saúde bucal no PSF, da inclusão ao momento atual: percepções de cirurgiões-dentistas e auxiliares no contexto de um município.	Ciência Odont. Brasil	Qualitative/RN	The professionals showed interaction with the community. However, only 4.65% of the respondents highlighted the HV, emphasizing the prevention of oral cancer. HVs are geared to pregnant, older adults and bedridden. The main approach is oral hygiene guidelines and identification of oral injuries.
Almeida e Ferreira (2008)²²	Saúde bucal no contexto do Programa Saúde da Família: práticas de prevenção orientadas ao indivíduo e ao coletivo.	Cad. de Saúde Pública	Quantitative/RN	Of the 91 DS, 43 performed HV, for the groups of: bedridden, older adults and individuals without mobility; pregnant women, mothers and newborns. The ACS identifies the individuals to be visited. Regarding home practices, the following is performed: oral hygiene and diet orientation; evaluation of living conditions and habits; incentive to self-examination of oral cancer. Regarding the proportion of HVs performed by physicians, nurses and other higher education professionals, ESB's HV represented only 20.5% when compared to other categories. The high demand for clinical care was one of the limitations to the performance of HVs.
Faccin et al. (2010)²³	Processo de trabalho em saúde bucal: em busca de diferentes olhares para compreender e transformar a realidade	Ciência & Saúde Coletiva	Qualitative/SC	Professionals express concerns about what to do in the HV. The HV is a useful resource for oral health if well delimited, such as in situations whose family dynamics interfere in the health-disease process, and the presence of the DS in loco brings benefits in understanding the user's reality. It establishes or strengthens the bond and can also be used for curative interventions in patients unable to move to the UBS, when equipment is available.
Emmi e Barroso (2008)³⁹	Avaliação das ações de saúde bucal no Programa Saúde da Família no distrito de Mosqueiro, Pará.	Ciência & Saúde Coletiva	Quantitative/PA	The home visits, mentioned by 30 users, enabled a greater contact with the professional, facilitated the attendance, and user travel to the facility in search of care was avoided. Major improvements for the sample population are, in this order: oral hygiene guidelines, greater access to care and HVs.
Pimentel et al. (2010)²⁴	Análise da atenção à saúde bucal na Estratégia de Saúde da Família do Distrito Sanitário VI, Recife (PE)	Ciência & Saúde Coletiva	Qualitative/PE	It was evidenced that several professionals of the team see the DS geared only to clinical care and that when he/she is attending at the clinic "he/she is doing nothing". Team believes that the DS should be inside the clinic only doing restoration, outpatient service and that he/she does not have to do HVs or go to school to give a lecture.
Moura et al. (2013)²⁶	Saúde bucal na Estratégia de Saúde da Família em um colegiado gestor regional do estado do Piauí	Ciência & Saúde Coletiva	Quantitative/PI	Only 27% carry out a multidisciplinary HV and in 48.6% of the cases the population is visited regardless of need. The HV has not yet been incorporated in the routine of the DS, its periodicity is irregular, and sites are designated by the ACS. The obstacles for multidisciplinary HV are: the team's priority for the activity; the availability of vehicles to drive the professionals; HV territories that are unsafe to walk to by foot.
Sanglard-Oliveira et al. (2013)²⁷	Atribuições dos Técnicos em Saúde Bucal na Estratégia Saúde da Família em Minas Gerais, Brasil.	Ciência & Saúde Coletiva	Quantitative/MG	Of the 231 OHT participants, 77.9% performed HVs and 15.2% performed clinical activities in the HVs, and the OHT is a multiplier agent and health educator, with direct extra-clinical intervention, participating in and collaborating in HV programming and in collective health actions. OHT have employed their time more into extra-clinical preventive/collective activities than into individual care activities.
Colussi e Calvo (2011)³⁷	Modelo de avaliação da saúde bucal na atenção básica.	Cad. de Saúde Pública	Quantitative/SC	11 municipalities in the state of Santa Catarina did not respond, and 71 said that none of their UBS performed oral health HV for elderly people with no mobility (bedridden). Disabling limitation should not be a deterrent to the provision of oral health care.
Szpilman e Oliveira (2011)⁴⁰	A Percepção dos usuários sobre os serviços de odontologia em UBS de Vila Velha (ES), Brasil.	Revista Espaço para a Saúde	Qualitative/ES	Users reported a high level of satisfaction with the HV, mainly the ACS. However, HVs were not performed by other professionals (doctors, nurses or dentists) due to lack of transportation, showing a barrier in access to users who did not have access to UBS.
Turrioni et al. (2012)²⁵	Avaliação das ações de educação na saúde bucal de adolescentes dentro da Estratégia de Saúde da Família.	Ciência & Saúde Coletiva	Quantitative/SP	Of the 3 groups of adolescents who participated, an increased number of adolescents with healthy gingiva or mild inflammation in the groups that received a HV by the ACS trained by the ESB and the activity at school was noted. It revealed the importance of joint planning of oral health education actions among health professionals and also for an age group that does not seek dental care, and which challenges ESB to systematize this access.
De-Carli et al. (2015)²⁸	Visita domiciliar e cuidado domiciliar na Atenção Básica: um olhar sobre a saúde bucal.	Saúde em Debate	Quantitative	Of the 17,202 health teams that joined the first cycle of the PMAQ, almost 100% of the evaluated EqSF performed HV. Home care is performed by more than 90% of EqSF professionals, and by approximately 50% of EqSB professionals. However, there are still challenges to be overcome to change ESB routine.
Kobayashi et al. (2015)³²	Risco familiar como elemento para organização da demanda em saúde bucal na ESF.	Revista Odontol. UNESP	Quantitative/SP	Card A was used as an instrument in the organization of the demand for HV by ESB according to the family risk to caries. People at risk would be twice as likely to have the disease compared to those without risk.
Maciel et al. (2016)³⁵	Quando a saúde bucal bate à porta: protocolo para a atenção domiciliar em odontologia.	Revista Bras. Promo. Saúde	Protocol/CE	The HVs focused on health education and promotion, the motivation for self-care and the stratification of risk for the intervention of the EqSB. The protocol included general health aspects, ascription to the ESF, information regarding oral health, indication of the need for intervention at home and/or at the UBS and referral to the secondary care service. The instrument evidenced good capacity of use in the work process in oral health provided by the teaching-service integration, qualifying the HV of the ESB.
Ferraz e Leite (2017)³⁴	Instrumentos de visita domiciliar: abordagem da Odontologia na ESF.	Revista de APS	Protocol/MG	The protocols were based on actions of health surveillance and directed to the HVs for patients with disabilities, puerperae/newborn and bedridden. A need for systematization of the HV by the DS was found, in the establishment of a more accurate diagnosis of the oral health situation of the population of the area of coverage of the UBS to reduce the stock of oral disease accumulated needs of these users.

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