Fatores associados à oferta de fisioterapia ambulatorial no Sistema Único de Saúde nos municípios brasileiros: estudo ecológico nacional

Abstract

Importance: Geographic disparities in the provision of outpatient physical therapy services (OPTS) within Brazil's Unified Health System (SUS) may reflect differences in both potential rehabilitation needs and socioeconomic conditions across municipalities. However, nationwide studies examining the combined influence of these factors remain limited. Objective: To investigate the factors associated with the provision of OPTS across Brazilian municipalities. Design/Setting: This ecological cross-sectional study analyzed secondary data from all 5.571 Brazilian municipalities. Multiple linear regression models were fitted using the stepwise method, with additional analyses stratified according to municipal population size. The dependent variable was Supplementary the OPTS Health Coefficient. Coverage Independent Coefficient, variables Hospital included Morbidity the Coefficient, Functional Limitations Coefficient, Autism Spectrum Disorder Coefficient, Disability Recipients of the Continuous Cash Benefit Program Coefficient, Older Adult Recipients of the Continuous Cash Benefit Program Coefficient, Older Adult Population Coefficient, Illiteracy Coefficient, and the Firjan Municipal Development Index. Results: At the national level, municipal development was the factor most strongly associated with OPTS (β = 0.102; P < .001). Positive associations were also observed for the proportion of disability benefit recipients (β = 0.070; P < .001), functional limitations (β = 0.067; P < .001), and older adult recipients of the Continuous Cash Benefit Program (β = 0.058; P < .001). In contrast, higher illiteracy rates were associated with lower OPTS (β = −0.094; P < .001). Supplementary health coverage remained significantly associated with the outcome only in Small Size I municipalities. The determinants of OPTS differed according to municipal population size. Conclusions: The availability of OPTS within the SUS is shaped by both indicators of potential rehabilitation demand and socioeconomic characteristics. These findings highlight the importance of incorporating measures of functional limitations, hospital morbidity, population aging, municipal development, and population size into health service planning to promote a more equitable distribution of OPTS.