Access to pulmonary rehabilitation programs within the public healthcare service

Giacomazzi, Cristiane Mecca

doi:10.1590/S1413-35552010000400014

LETTER TO THE EDITOR

I congratulate the authors for providing the "Clinical Practice Guidelines: physical therapy practice among patients with chronic obstructive pulmonary disease (COPD)"¹. These guidelines, together with other national and international studies, have successfully shown, with strong evidence, the role of physical therapists in this growing public health problem. However, routine access to such programs has not yet been achieved.

In order to benefit from the results of pulmonary rehabilitation programs (PRPs), patients have to go to a rehabilitation center. This means personal and even family scheduling and weekly or monthly expenses relating to transportation, especially if the program is provided in another city. The difficulties can be worsened if the subject is dependent on oxygen, given that the cylinders are heavy and do not last long.

The Brazilian Constitution³ proposes universal and equal access to health actions and services, including rehabilitation, which should be comprehensive, universal and equitable. These principles are a challenge for care practice. The history of the process of healthcare organization demonstrates the difficulties found in PRP functioning, through the verticalization that divides and complicates the solutions for problems, and through flaws in work organization within healthcare services, including physical therapy, starting from epidemiology⁴.

The study by Griffiths et al.⁵ shows that PRPs have a good cost-effectiveness relationship, which can result in financial benefits for the public healthcare system, such as reductions in the numbers of hospitalization days, visits to emergency units, and need for medication. In this manner, PRPs for users of the public healthcare system can be justified as a measure that may result, in the long run, in decreased expenditure on COPD patients.

The process of developing a PRP within the public health system is still a challenge for physical therapists and for the system itself. It is essential to draw up strategies to increase patients' access to these programs, in order to consolidate the proposal. In conclusion, studies on the incorporation of PRPs within the public healthcare system need to be conducted, and physical therapists should have the responsibilities of broadening their fields of work, raising managers' awareness and demonstrating the need to apply other practices in the public system to better suit users⁶.

Sincerely,

Cristiane Mecca Giacomazzi

Physical Therapist

1. Langer D, Probst VS, Pitta F, Burtin C, Hendriks E, Schans CPVD, et al . Guia para prática clínica: fisioterapia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC). Rev Bras Fisioter. 2009;13(3):183-204.
2. Roceto LS, Takara LS, Machado L, Zambon L, Saad IAB. Eficácia da reabilitação pulmonar uma vez na semana em portadores de doença pulmonar obstrutiva. Rev Bras Fisioter. 2007;11(6):475-80.
³
BRASIL. Constituição da República Federativa do Brasil. 1988. Disponível em: http://www.planalto.gov.br/ccivil_03/Constituicao/Constituiçao.htm
4. Pinheiro R, Mattos RA. Os sentidos da integralidade na atenção e no cuidado à saúde 6Ş ed. Rio de Janeiro: IMS/UERJ - CEPESC - ABRASCO; 2006.
5. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56(10):779-84.
6. Santos FAS, Gouveia GC, Martelli PJL, Vasconcelos EMR. Acupuntura no Sistema Único de Saúde e a inserção de profissionais não-médicos. Rev Bras Fisioter. 2009;13(4):330-4.