title: A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil.
abstract: Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.
authors.affiliation: a Graduate Program in Collective Health, Federal University of Rio Grande Do Norte , Natal , Brazil.
authors.forename: Kelienny de Meneses
authors.initials: KM
authors.lastname: Sousa
authors.affiliation: a Graduate Program in Collective Health, Federal University of Rio Grande Do Norte , Natal , Brazil.
authors.forename: Wagner Ivan Fonsêca de
authors.initials: WI
authors.lastname: Oliveira
authors.affiliation: b Physiotherapy School, Federal University of Rio Grande do Norte , Natal , Brazil.
authors.forename: Laiza Oliveira Mendes de
authors.initials: LO
authors.lastname: Melo
authors.affiliation: c Medical School, Federal University of Rio Grande do Norte , Natal , Brazil.
authors.forename: Emanuel Augusto
authors.initials: EA
authors.lastname: Alves
authors.affiliation: d Department of Collective Health, Federal University of Rio Grande Do Norte , Natal , Brazil.
authors.forename: Grasiela
authors.initials: G
authors.lastname: Piuvezam
authors.affiliation: d Department of Collective Health, Federal University of Rio Grande Do Norte , Natal , Brazil.
authors.forename: Zenewton André da Silva
authors.initials: ZA
authors.lastname: Gama
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D001938:Brazil; D002648:Child; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research
keywords: Brazil; health services accessibility; quality of health care; rehabilitation; traffic accidents