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Previous issue date: 2015-06-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Os servi?os de Reabilita??o F?sica (RF) t?m import?ncia fundamental no enfrentamento da
epidemia global dos Acidentes de Tr?nsito (AT). Considerando as in?meras sequelas f?sicas e
sociais dos sobreviventes, problemas de qualidade no acesso ? RF constituem um agravo ?
recupera??o das v?timas. Faz-se necess?rio implementar a gest?o da qualidade destes servi?os,
avaliando dimens?es priorit?rias e intervindo nos seus fatores determinantes, a fim de garantir
RF dispon?vel em tempo e condi??es oportunas. Objetivou-se identificar barreiras de acesso ?
RF considerando a percep??o das v?timas de AT e dos profissionais de sa?de, bem como estimar
o acesso ? RF e seus fatores associados. Trata-se de uma pesquisa quali-quantitativa de natureza
explorat?ria desenvolvida em Natal/RN com entrevistas semiestruturadas a 19 profissionais de
sa?de e de inqu?rito telef?nico a 155 v?timas de AT. Para explorar as barreiras de acesso os
discursos foram transcritos e analisados com o software Alceste, vers?o 4.9. Durante as
entrevistas utilizou-se a seguinte pergunta norteadora: ?Que barreiras dificultam ou impedem
o acesso ? reabilita??o f?sica para v?timas de acidentes de tr?nsito??. A denomina??o das
classes e eixos resultantes do Alceste foi realizada por consulta ad hoc a tr?s pesquisadores
externos com posterior consenso da denomina??o mais representativa. Realizou-se an?lise
multivariada da influ?ncia das vari?veis do acidente, sociodemogr?ficas, cl?nicas e assistenciais
sobre o acesso ? RF. As associa??es que apresentaram p<0,20 na an?lise bivariada foram
submetidas ? regress?o log?stica, passo a passo, com p<0,05 e Intervalo de Confian?a (IC) de
95%. As principais barreiras identificadas foram: ?Regula??o burocr?tica do acesso?, ?Demora
para o acesso?, ?N?o encaminhamento p?s-cirurgia? e ?Inefici?ncia dos servi?os p?blicos?.
Essas barreiras foram distribu?das em um modelo te?rico constru?do a partir do diagrama de
causa-efeito, no qual se observou que o acesso insuficiente ? RF ? produto das causas associadas
? estrutura organizacional, processos de trabalho, profissionais e usu?rios. Constru?ram-se dois
modelos de regress?o: ?Acesso geral ? RF? e ?Acesso ao servi?o p?blico de RF?. Obtiveram
acesso ? RF 51,6% dos usu?rios, sendo 32,9% na rede p?blica e 17,9% no servi?o privado. O
modelo de regress?o ?Acesso Geral ? RF? foi composto pelas vari?veis ?Renda Familiar? (OR:
3,7), ?Trabalhador informal? (OR: 0,11), ?Desempregado? (OR: 0,15), ?Necessidade percebida
de RF? (OR:10,0) e ?Encaminhamento para RF? (OR: 27,5). O modelo ?Acesso ? RF no servi?o
p?blico? foi representado pelo ?Encaminhamento para RF? (OR: 23,0) e ?Plano Privado de
Sa?de? (OR: 0,07). Apesar da conhecida influ?ncia dos determinantes sociais sobre o acesso
aos servi?os de sa?de, situa??o de dif?cil controle pela gest?o p?blica, este estudo encontrou
que os processos organizativos e burocr?ticos estabelecidos na assist?ncia em sa?de determinam sobremaneira o acesso ? RF. As falhas no acesso sinalizam a import?ncia do
problema, e os fatores associados apontam para interven??es na gest?o do cuidado integral, a
fim de melhorar a qualidade e o acesso ? reabilita??o f?sica e evitar prolongamento
desnecess?rio do sofrimento dos sobreviventes da epidemia de AT. / 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
(OR:3.7), Informal Employment (OR:0.11), Unemployment (OR:0.15), Perceived Need for
PR (OR:10) 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.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/20194 |
| Date | 01 June 2015 |
| Creators | Sousa, Kelienny de Meneses |
| Contributors | 01016659466, http://lattes.cnpq.br/8885774273217562, Medeiros J?nior, Antonio, 15495728491, http://lattes.cnpq.br/8911091115987549, Travassos, Cl?udia Maria de Rezende, 43665829704, http://lattes.cnpq.br/5585204991017721, Gama, Zenewton Andr? da Silva |
| Publisher | Universidade Federal do Rio Grande do Norte, PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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