Acessibilidade geográfica na rede de cuidados à pessoa com deficiência do estado de Minas Gerais: análise no componente especializado

Abstract

The implementation of the Care Network for People with Disabilities in Minas Gerais (RCPD-MG) expanded the provision of specialized health services to the target population. The term accessibility is complex, and its definition varies among authors. This study assesses geographic accessibility, measured by the distance between the health facility and the user’s residence, as well as by travel time and transportation means. This analysis contributes to understanding user flows and supports the organization and regionalization of health services. The objectives were to analyze users’ accessibility to the specialized component of the RCPD-MG; identify and describe the origin-destination paths according to place of residence and care, age, type of disability, service modality, and satisfaction with the network; and verify the association between travel distance and user satisfaction. This is an observational, analytical, cross-sectional study with a probabilistic sample stratified by the 13 expanded health regions, based on the number of specialized RCPD services in each region. The study setting was the specialized component of the RCPD-MG, established in 2012. Data were collected using the Structured Script for Users of the Care Network for People with Disabilities of SUS-MG, developed by the authors and applied through interviews. Sociodemographic variables (sex, age, income, education) and user satisfaction were analyzed. The response variables were the place of care (within or outside the municipality of residence) and distance traveled. Explanatory variables included sociodemographic factors, type of disability, service modality, socioeconomic class, and satisfaction with access to health services. Descriptive analyses and association tests (Pearson’s Chi-square, Fisher’s exact test, t-test, and Mann-Whitney) were conducted, with a significance level of p ≤ 0.05. Data analysis was performed using the Statistical Package for Social Sciences (SPSS), version 21.0. Most users were male, children or adolescents, belonging to socioeconomic class C, and had incomplete elementary education. Significant associations were found between being treated within the municipality of residence and socioeconomic class, as well as between receiving care outside the municipality and satisfaction with access and appointments outside the municipality. Among users treated outside their municipality, adults traveled the longest distances, though not statistically significant. The greatest distances were observed among users from classes A and B and those with physical, hearing, intellectual, or visual disabilities. It is concluded that the geographic accessibility of RCPD-MG users is related to sociodemographic factors and satisfaction with services. The study confirms that the regionalization proposed by the Health Regionalization Master Plan in Minas Gerais has been implemented, although territorial equity challenges remain.