IADR Abstract Archives
Healthcare Accessibility Can Attenuate Socioeconomic Inequalities in Dental Services Utilization
Objectives: To identify the potential moderating effect of healthcare accessibility on individual and contextual determinants of dental services use within Brazilian Primary Health Care (PHC).
Methods: Cross-sectional study, using secondary databases available by the Ministry of Health. It encompassed a sample of 4.796 individuals interviewed at the waiting rooms of 951 facilities served by the 1.308 dental health teams that applied for external evaluation in the National Program for Improvement of Access and Quality of Primary Health Care (PMAQ-AB) in the State of Parana, Brazil, in 2017. The independent factors were selected in order to fit a hierarchical explicative model: 1 – contextual level (state healthcare administrative region, Municipal Human Development Index, city population size and coverage of Primary Dental Care); 2 – individual level (sex, age, ethnicity, schooling, marital status, income); 3 – healthcare accessibility (distance between the residence and the facility, characteristics of the PHC delivered). Multivariate models of logistic regression analysis considered the use of dental services as dependent variable.
Results: We observed high prevalence of use of the facilities for medical care as scheduling appointments (80.8%) or vaccination (74.8%), but only 46.4% of the sample referred dental services utilization. Social gradients were independently associated to dental services usage, both at contextual and individual levels, and remained included in the multivariate analysis. When dental care accessibility fitted the model, socioeconomic conditions and the geographical barrier lost statistical significance. In the final model, use of dental services remained related to sex (women), age (younger), access to first contact and longitudinality of dental care.
Conclusions: The mere availability of dental services does not guarantee widespread access to dental care at PHC facilities. Although it was not able to eliminate the impact of demographic factors, higher healthcare accessibility favored the use of dental services and seems to attenuate socioeconomic inequalities.
Methods: Cross-sectional study, using secondary databases available by the Ministry of Health. It encompassed a sample of 4.796 individuals interviewed at the waiting rooms of 951 facilities served by the 1.308 dental health teams that applied for external evaluation in the National Program for Improvement of Access and Quality of Primary Health Care (PMAQ-AB) in the State of Parana, Brazil, in 2017. The independent factors were selected in order to fit a hierarchical explicative model: 1 – contextual level (state healthcare administrative region, Municipal Human Development Index, city population size and coverage of Primary Dental Care); 2 – individual level (sex, age, ethnicity, schooling, marital status, income); 3 – healthcare accessibility (distance between the residence and the facility, characteristics of the PHC delivered). Multivariate models of logistic regression analysis considered the use of dental services as dependent variable.
Results: We observed high prevalence of use of the facilities for medical care as scheduling appointments (80.8%) or vaccination (74.8%), but only 46.4% of the sample referred dental services utilization. Social gradients were independently associated to dental services usage, both at contextual and individual levels, and remained included in the multivariate analysis. When dental care accessibility fitted the model, socioeconomic conditions and the geographical barrier lost statistical significance. In the final model, use of dental services remained related to sex (women), age (younger), access to first contact and longitudinality of dental care.
Conclusions: The mere availability of dental services does not guarantee widespread access to dental care at PHC facilities. Although it was not able to eliminate the impact of demographic factors, higher healthcare accessibility favored the use of dental services and seems to attenuate socioeconomic inequalities.