Saúde bucal e acesso de pessoas com doença falciforme na atenção primária nos municípios do estado do Rio de Janeiro entre 2013 e 2023: o que (não) dizem os sistemas de informação em saúde?

Abstract

Access to oral health and the use of the Unified Health System are directly related to (mis)information through health records provided by the systems, since they support decisionmaking by managers. Sickle cell disease (SCD) is a hereditary genetic hemoglobinopathy and a public health problem with repercussions on oral health (OH). SCD demands educational, preventive and curative actions – the latter provided, especially in primary health care (PHC) due to its early diagnosis in biological neonatal screening. This favors access to dental services and oral health teams at this level of care and navigation in the oral health care network. Health information systems (HIS) support the planning and decision-making of professionals and managers since they allow the systematization of data and the collection of individual and collective information, which is essential for qualifying specific public policies. Therefore, to a certain extent, they can measure access. This study aimed to analyze, through the HIS, the access of users with SCD to dental consultations in PHC in the state of Rio de Janeiro (RJ) between 2013 and 2023. This was an ecological study with secondary data from the HIS of Primary Care (SISAB), Outpatient (SIA) - open; and SESRJ with restricted access (HIS Webhemoglobinopathies, Horus and SESRJ/state - HEMORIO) for ICD 10 D 57, 57.0, 57.1, 52.7 and 57.8, between 2013 and 2023, in the 92 municipalities of RJ. For this, data on social profile, medical condition, use of hydroxyurea, OH teams, OH team coverage, outpatient consultation and access to dental consultation in the respective ICD and HIS mentioned above were crossed. 4,671 case records of people with SCD were obtained, which represented 3 people with SCD for every 10,000 inhabitants. Of these, approximately 68% had sickle cell anemia. The high percentage of incompleteness (99.78%) regarding race/color in the HIS made racialized analysis unfeasible. There were more records of clinical care for women (56%). OH coverage showed a tendency towards stability in most municipalities during the period studied. However, having coverage did not guarantee access to oral health services. Piraí, São José do Vale do Rio Preto (66.67%) and Cantagalo (58.33%) had the best performance in the proportion of dental care provided in PHC/people with SCD, but did not reach 01 (one) care per person with SCD/year. The age group that presented the highest proportion of OH care was 0-9 years (29%). There was no record of OH care in 42% of the municipalities with records of people with SCD in the HIS.The records about SCD in the HIS tell us that the accessoral health in PHC is very limited or even non-existent in some municipalities, showing barriers to access to oral health. The impossibility of racialized analysis is an expression of racism.There is an urgent need to implement public policies for the oral health of people with SCD in the state of Rio de Janeiro to guarantee the principle of equity.