ACESSIBILIDADE PARA PESSOAS COM DEFICIÊNCIA MOTORA NOS SERVIÇOS ESPECIALIZADOS DE SAÚDE BUCAL NO BRASIL: Estudo ecológico com ênfase em barreiras físicas

Abstract

Introduction: Accessibility to health services is essential so that People with motor Disabilities (acronym in Portuguese, PCDm) can have their rights to health respected. Little is known about the physical barriers that make it difficult for PCDm to access public health services. The objective of this study is to evaluate physical accessibility, aimed at PCDm, in Dental Specialty Centers (acronym in Portuguese, CEOs) in Brazil, analyzing possible changes over time. Methods: This is a national ecological study, with secondary data from the external evaluation of the two cycles of the Access and Quality Improvement Program (acronym in Portuguese, PMAQ) of the CEOs, carried out in 2014 and 2018. The CEOs were the units of analysis (n=889 evaluated in both cycles). Descriptive and latent transition analyzes were carried out considering the physical accessibility variables aimed at accessibility for PCDm: corridors and doors adapted for wheelchairs; wheelchairs in usable condition; access ramp with handrail; and adapted bathrooms. Models were created and tested with different numbers of Latent Status (LS), from two to six, choosing the one that presented the best concept and appropriate quality of fit: lowest chi-square value of the likelihood ratio test, Criterion values Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) above 0.9 and entropy close to 1.0. Results: The Northeast region had the highest proportion of CEOs in the country (38.4%) and the North region had the lowest (6.4%). The model chosen was five LS, named: LS1 (most accessible); LS2 (disability doors and bathrooms); LS3 (deficiency of ramps and bathrooms); LS4 (wheelchair disability); and LS5 (less accessible). There was an improvement in all physical accessibility indicators of the Brazilian CEOs analyzed: adaptation for wheelchairs in corridors (9.7% increase) and doors (4.9%); suitable wheelchairs (15.7%); access ramps with handrails (38.7%); and bathrooms adapted for PCDm (19.6%). There was an increase in the number of CEOs in LS1 and a reduction in LS5. Conclusion: Comparing the two PMAQ-CEO cycles, there was a reduction in physical barriers in CEOs to PCDm, in all Brazilian states, favoring physical accessibility for users.