Avaliação do acesso aos serviços de reabilitação física para vítimas de acidentes de trânsito: caminhos para melhoria da qualidade do sistema de saúde / Evaluation of access to physical rehabilitation services for victims of traffic accidents: ways to improve the quality of health care

RESUMO

Os serviços de Reabilitação Física (RF) têm importância fundamental no enfrentamento da epidemia global dos Acidentes de Trânsito (AT). Considerando as inúmeras sequelas físicas e sociais dos sobreviventes, problemas de qualidade no acesso à RF constituem um agravo à recuperação das vítimas. Faz-se necessário implementar a gestão da qualidade destes serviços, avaliando dimensões prioritárias e intervindo nos seus fatores determinantes, a fim de garantir RF disponível em tempo e condições oportunas. Objetivou-se identificar barreiras de acesso à RF considerando a percepção das vítimas de AT e dos profissionais de saúde, bem como estimar o acesso à RF e seus fatores associados. Trata-se de uma pesquisa quali-quantitativa de natureza exploratória desenvolvida em Natal/RN com entrevistas semiestruturadas a 19 profissionais de saúde e de inquérito telefônico a 155 vítimas de AT. Para explorar as barreiras de acesso os discursos foram transcritos e analisados com o software Alceste, versão 4.9. Durante as entrevistas utilizou-se a seguinte pergunta norteadora “Que barreiras dificultam ou impedem o acesso à reabilitação física para vítimas de acidentes de trânsito?”. A denominação das classes e eixos resultantes do Alceste foi realizada por consulta ad hoc a três pesquisadores externos com posterior consenso da denominação mais representativa. Realizou-se análise multivariada da influência das variáveis do acidente, sociodemográficas, clínicas e assistenciais sobre o acesso à RF. As associações que apresentaram p<0,20 na análise bivariada foram submetidas à regressão logística, passo a passo, com p<0,05 e Intervalo de Confiança (IC) de 95%.

ABSTRACT

The Physical Rehabilitation services (PR) are of fundamental importance in combating the global epidemic of Traffic Accidents (TA). Considering the numerous physical and social consequences of the survivors, quality problems in access to PR are a hazard to recovery of victims. It is necessary to improve the management of quality of services, assessing priority dimensions and intervening in their causes, to ensure rehabilitation available in time and suitable conditions. This study aimed to identify barriers to access to rehabilitation considering the perception of TA victims and professionals. The aim is also to estimate the access to rehabilitation and their associated factors. This is a qualitative and quantitative study of exploratory nature developed in Natal / RN with semi-structured interviews with 19 health professionals and telephone survey to 155 victims of traffic accidents. To explore barriers to access the speeches were transcribed and analyzed using the Alceste software (version 4.9). During the interviews used the following guiding question "What barriers hinder or prevent access to physical rehabilitation for victims of traffic accidents?". The names of classes and axes resulting from Alceste was performed by ad hoc query to three external researchers with subsequent consensus of the most representative name of analysis. We conducted multivariate analysis of the influence of the variables of the accident, sociodemographic, clinical and assistance on access to rehabilitation. Associations with p <0.20 in the bivariate analysis were submitted to logistic regression, step by step, with p <0.05 and confidence interval (CI) of 95%. The main barriers identified were "Bureaucratic regulation", "Long time to start rehabilitation", "No post-surgery referral" and "inefficiency of public services". These barriers were divided into a theoretical model built from the cause-effect diagram, in which we observed that insufficient access to rehabilitation is the product of causes related to organizational structure, work processes, professional and patients. Was constructed two logistic regression models "General access to rehabilitation" and "Access to rehabilitation to public service". 51.6% of patients had access to rehabilitation, and 32.9% in public and 17.9% in the private sector. The regression model "General access to rehabilitation" included the variables Income (OR3.7), Informal Employment (OR0.11), Unemployment (OR0.15), Perceived Need for PR (OR10) and Referral (OR 27.5). The model "Access to rehabilitation in the public service" was represented by the "Referral to Public Service" (OR 23.0) and "Private Health Plan" (OR 0.07). Despite the known influence of social determinants on access to health services, a situation difficult to control by the public administration, this study found that the organizational and bureaucratic procedures established in health care greatly determine access to rehabilitation. Access difficulties show the seriousness of the problem and the factors suggest the need for improvements in comprehensive care for TA survivors and avoid unnecessary prolongation of the suffering of the victims of this epidemic. (AU)