Análise espaço-temporal da distribuição de fisioterapeutas e de atendimentos fisioterapêuticos ambulatoriais no sistema único de saúde, Brasil

Abstract

The provision of physical therapy services in the SUS is marked by inequalities. This thesis analyzed the spatiotemporal distribution of physical therapists and outpatient care in the SUS in Brazil and Maranhão (MA). Two ecological studies were conducted using official public data. The first investigated the evolution in the number of physical therapists and visits in Brazil from 2008 to 2019, in relation to per capita Gross Domestic Product (GDP) and per capita SUS budget. The second analyzed the distribution of these professionals and outpatient production in MA from 2022 to 2024, considering socioeconomic, demographic, structural, mobility, and accessibility factors. Analyses included covariance, Pearson correlations, and Tukey’s test in the national study, and association tests, Moran’s indices, and spatial regression in the Maranhão study. In Brazil, GDP per capita showed a positive correlation with physical therapists in all federative units (FUs) and with visits in seven FUs, especially Paraíba (r=0.96), Acre (r=0.88), and Amazonas (r=0.84). Visits correlated with per capita SUS budget in Acre (r=0.84), Amazonas (r=0.76), Tocantins (r=0.73), Paraíba (r=0.65), and Rondônia (r=0.64). In Maranhão, municipalities with coverage <1 physical therapist/10,000 inhabitants decreased from 53 to 19, those with rates ≥6.67/10,000 increased from 1 to 9, and more than 120 municipalities had no recorded visits. High-High clusters of coverage and production were concentrated in the eastern, central-eastern, and western areas. Physical therapist coverage was associated with specialty centers (β=0.115) and per capita SUS budget (β=0.001) in health regions, and with GDP per capita (β=6.839) and polyclinics (β=0.298) in municipalities. Visits were associated with trauma hospitals (β=188.252) in health regions, and with primary health care units (β=2.190), trauma hospitals (β=4.559), and hospitalizations for musculoskeletal surgeries (β=589.786) in municipalities. It is concluded that, in Brazil, GDP per capita and SUS budget per capita were positively associated with the availability of physical therapists and outpatient production, especially in the Northern FUs. In Maranhão, territorial inequalities and care gaps persisted in the provision of physical therapy in the SUS, associated with socioeconomic and structural factors..