Outpatient physical therapy in the municipalities and macroregions of Minas Gerais: an ecological study

Abstract

Introduction: Specialized care in outpatient physical therapy can be provided through secondary health care, which involves more specific and complex technological resources than primary health care. Despite the large percentage of professionals providing services at this level of care, access to physical therapy services is unequal and relatively lacking in Brazil. Objective: To identify the percentage of municipalities with outpatient physical therapy services by macroregion in Minas Gerais (MG) and to evaluate the attendance coefficient for physical therapy services according to the population sizes of the municipalities. Methods: This was an ecological study of data from the Outpatient Information System of the Unified Health System (Sistema Único de Saúde, SUS) and population data from the 2022 Census. The municipalities were categorized into four groups (small I, small II, medium and large). The Kruskal‒Wallis and Mann‒Whitney tests were used to compare the attendance coefficients between the groups. To clarify care gaps and visualize asymmetry in the attendance coefficients, a georeferencing map was constructed. Results: The coverage of outpatient physical therapy services was 58.1%. The West macroregion, which is composed of 53 municipalities, had the highest coverage ranking. The attendance coefficients for physical therapy care in MG and all of Brazil were 0.19 and 0.24, respectively, whereas the median coefficient for all municipalities was 0.18 (Q1 and Q3: 0.08 and 0.34, respectively). No significant differences were found in the attendance coefficients among the four groups. Twelve municipalities presented atypically positive values and were thus identified as care references. Conclusion: The availability and provision of outpatient physical therapy services by the SUS are relatively lacking and heterogeneous among the different municipalities and macroregions of MG. The size of the municipality is not a relevant indicator of the proportional number of outpatient care. The Ministry of Health from Brazil must establish guidelines defining care referrals for physical therapy services.