Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais

Marcolino, Milena Soriano; Oliveira, João Antonio de Queiroz; Silva, Grace Kelly Matos e; Dias, Thatiane Dantas; Marino, Barbara Campos Abreu; Antunes, André Pires; Ribeiro, Antonio Luiz; Cardoso, Clareci Silva

doi:10.5935/abc.20180143

Tabla de contenido Anterior Actual Siguiente

Tabla de contenido

Original Article • Arq. Bras. Cardiol. 111 (2) • Aug 2018 • https://doi.org/10.5935/abc.20180143 linkcopy

Satisfaction of Emergency Physicians with the Care Provided to Patients with Cardiovascular Diseases in the Northern Region of Minas Gerais

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background: The dissatisfaction of health professionals in emergency services has a negative influence on both the quality of care provided for acute myocardial infarction (AMI) patients and the retention of those professionals.

Objective: To assess physicians’ satisfaction with the structure of care and diagnosis at the emergency services in the Northern Region of Minas Gerais before the implementation of the AMI system of care.

Methods: This cross-sectional study included physicians from the emergency units of the ambulance service (SAMU) and level II, III and IV regional hospitals. Satisfaction was assessed by using the CARDIOSATIS-Team scale. The median score for each item, the overall scale and the domains were calculated and then compared by groups using the non-parametric Mann-Whitney test. Correlation between time since graduation and satisfaction level was assessed using Spearman correlation. A p value < 0.05 was considered significant.

Results: Of the 137 physicians included in the study, 46% worked at SAMU. Most of the interviewees showed overall dissatisfaction with the structure of care, and the median score for the overall scale was 2.0 [interquartile range (IQR) 2.0-4.0]. Most SAMU physicians expressed their dissatisfaction with the care provided (54%), the structure for managing cardiovascular diseases (52%), and the technology available for diagnosis (54%). The evaluation of the overall satisfaction evidenced that the dissatisfaction of SAMU physicians was lower when compared to that of hospital emergency physicians. Level III/IV hospital physicians expressed greater overall satisfaction when compared to level II hospital physicians.

Conclusion: This study showed the overall dissatisfaction of the emergency physicians in the region assessed with the structure of care for cardiovascular emergencies.

Keywords:
Cardiovascular Diseases; Myocardial Infartion; Acute Coronary Syndrome; Epidemiology; Health Profile; Quality Indicators, Health Care; Emergency Medical Services

Characteristics	Overall total (n = 137)	Non-SAMU (n = 74)			SAMU (n = 63)
Characteristics	Overall total (n = 137)	Level II hospitals (n = 28)	Level III/IV hospitals (n = 46)	Non-SAMU total (n = 74)	SAMU (n = 63)
Time since graduation (years) (median, IQR)	5.3 (1.8-12.7)	2.3 (1.5-5.0)*	11.0 (2.4-23.2)*	5.5 (1.9-15.3)†	5.3 (1.8-10.7)†
Male sex	93 (67.9)	13 (46.4)	35 (76.1)	48 (64.9)	45 (71.4)
Medical category/specialty
Generalist	43 (31.4)	12 (42.9)	8 (17.4)	20 (27.0)	23 (36.5)
Specialty	94 (68.6)	16 (57.1)	38 (82.6)	54 (73.0)	40 (63.5)
Internal medicine	40 (29.1)	9 (32.1)	18 (39.1)‡	27 (36.4)‡	13 (20.6)
Pediatrics	13 (9.4)	3 (10.7)	5 (10.8)	8 (10.8)	5 (7.9)
Surgery	10 (7.2)	1 (3.5)	4 (8.6)‡	5 (6.7)‡	5 (7.9)
Gynecology and Obstetrics	10 (7.2)	1 (3.5)	6 (13)‡	7 (9.4)‡	3 (4.7)
Cardiology	4 (2.9)	0 (0)	0 (0)	0 (0)	4 (6.3)
Family Medicine	4 (2.9)	0 (0)	0 (0)	0 (0)	4 (6.3)
Others§	16 (11.6)	2 (7.1)	8 (17.3)‡	10 (13.5)‡	6 (9.5)

Domains/Itens of the scale	Overall (n = 137)	Non-SAMU (n = 74)				SAMU (n = 63)	Comparison between SAMU and non-SAMU(p-value)*
Domains/Itens of the scale	Overall (n = 137)	Level II hospitals (n = 28)	Level III/IV hospitals (n = 46)	Non-SAMU total (n = 74)	Comparison between level II hospitals and level III/IV hospitals (p-value)*	SAMU (n = 63)	Comparison between SAMU and non-SAMU(p-value)*
Domain 1: Satisfaction with the care provided (5 items)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	0.96	2.0 (2.0-4.0)	0.05
Satisfaction with the care provided	2.0 (2.0-4.0)	4.0 (4.0-4.0)	3.5 (2.0-4.0)	4.0 (2.0-4.0)	0.38	2.0 (2.0-4.0)	0.87
Municipality's structure for diagnosis	2.0 (2.0-4.0)	2.0 (2.0-4.0)	2.0 (2.0-3.0)	2.0 (2.0-3.5)	0.49	2.0 (2.0-4.0)	0.03
Structure for managing cardiovascular diseases	2.0 (2.0-4.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	0.34	2.0 (2.0-4.0)	0.59
Diagnostic accuracy	2.0 (2.0-4.0)	2.0 (2.0-2.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	≤ 0.05	2.0 (2.0-4.0)	0.01
Technical support	5.0 (5.0-5.0)	5.0 (5.0-5.0)	5.0 (1.0-5.0)	5.0 (1.0-5.0)	0.50	5.0 (5.0-5.0)	≤ 0.01
Domain 2: Structure of care and diagnosis (6 items)	2.5 (2.0-3.5)	2.0 (2.0-2.0)	2.5 (2.0-3.5)	2.0 (2.0-3.0)	≤ 0.001	3.0 (2.0-4.0)	≤ 0.001
Medical facilities for the diagnosis of cardiovascular diseases	3.0 (2.0-4.0)	1.0 (1.0-2.0)	3.0 (2.0-4.0)	3.0 (2.0-3.0)	≤ 0.001	3.0 (2.0-4.0)	≤ 0.001
Quality of the equipment and materials	3.0 (2.0-3.0)	2.0 (2.0-2.0)	3.0 (2.0-3.0)	3.0 (2.0-3.0)	0.12	3.0 (3.0-4.0)	≤ 0.001
Technology available for diagnosis	2.0 (2.0-3.5)	2.0 (2.0-2.0)	2.0 (2.0-3.0)	2.0 (2.0-3.0)	0.66	2.0 (2.0-4.0)	≤ 0.001
Promptness in diagnosis	2.0 (2.0-3.5)	2.0 (2.0-2.0)	2.0 (2.0-4.0)	2.0 (2.0-3.0)	≤ 0.01	2.0 (2.0-4.0)	≤ 0.001
Adequacy of the service	3.0 (2.0-3.0)	2.0 (1.0-2.0)	3.0 (3.0-3.0)	3.0 (2.0-3.0)	≤ 0.001	3.0 (3.0-4.0)	≤ 0.001
Resolutivity	2.0 (2.0-4.0)	2.0 (2.0-2.0)	2.0 (2.0-4.0)	2.0 (2.0-4.0)	≤ 0.001	3.0 (2.0-4.0)	≤ 0.001
Overall scale (11 items)	2.0 (2.0-4.0)	2.0 (2.0-2.0)	3.0 (2.0-4.0)	2.0 (2.0-3.0)	≤ 0.05	2.0 (2.0-4.0)	≤ 0.001

Domains/Itens of the scale	SAMU (n = 63)			Non-SAMU (n = 74)
Domains/Itens of the scale	Dissatisfied (1-2)	Neither (3)	Satisfied (4-5)	Dissatisfied (1-2)	Neither (3)	Satisfied (4-5)
Domain 1: Satisfaction with the care provided (5 items)
Satisfaction with the care provided	34 (54.0)	1 (1.6)	28 (44.4)	37 (50.0)	7 (9.5)	30 (40.5)
Municipality's structure for diagnosis	29 (46.0)	3 (4.8)	31 (49.2)	49 (66.2)	8 (10.8)	17 (23.0)
Structure for managing cardiovascular diseases	33 (52.4)	7 (11.1)	22 (34.9)	46 (62.2)	7 (9.5)	21 (28.4)
Diagnostic accuracy	25 (39.7)	10 (15.9)	28 (44.4)	44 (59.5)	14 (18.9)	13 (17.6)
Technical support	9 (14.3)	-	52 (82.5)	11 (14.9)	-	52 (70.3)
Domain 2: Structure of care and diagnosis (6 items)
Medical facilities for the diagnosis of cardiovascular diseases	20 (31.8)	14 (22.2)	29 (46.0)	42 (56.8)	18 (24.3)	13 (17.6)
Quality of the equipment and materials	11 (17.5)	31 (49.2)	21 (33.3)	34 (46.0)	34 (46.0)	5 (6.8)
Technology available for diagnosis	34 (54.0)	9 (14.3)	20 (31.8)	58 (78.4)	7 (9.5)	9 (12.2)
Promptness in diagnosis	30 (47.6)	6 (9.5)	27 (42.9)	52 (70.3)	11 (14.9)	11 (14.9)
Adequacy of the service	10 (15.9)	30 (47.6)	23 (36.5)	40 (54.1)	24 (32.4)	7 (9.5)
Resolutivity	26 (41.3)	11 (17.5)	26 (41.3)	49 (66.2)	11 (14.9)	12 (16.2)

Domains/Itens of the scale	Level II hospitals (n = 28)			Level III/IV hospitals (n = 46)
Domains/Itens of the scale	Dissatisfied (1-2)	Neither (3)	Satisfied (4-5)	Dissatisfied (1-2)	Neither (3)	Satisfied (4-5)
Domain 1: Satisfaction with the care provided (5 items)
Satisfaction with the care provided	13 (46.4)	1 (3.6)	14 (50.0)	24 (52.2)	6 (13.0)	16 (34.8)
Municipality's structure for diagnosis	18 (64.3)	2 (7.1)	8 (28.6)	31 (67.4)	6 (13.0)	9 (19.6)
Structure for managing cardiovascular diseases	16 (57.1)	2 (7.1)	10 (35.7)	30 (65.2)	5 (10.9)	11 (23.9)
Diagnostic accuracy	21 (75.0)	4 (14.3)	2 (7.1)	23 (50.0)	10 (21.7)	11 (23.9)
Technical support	9 (32.1)	-	19 (67.9)	18 (39.1)	-	27 (58.7)
Domain 2: Structure of care and diagnosis (6 items)
Medical facilities for the diagnosis of cardiovascular diseases	24 (85.7)	1 (3.6)	3 (10.7)	18 (39.1)	17 (37.0)	10 (21.7)
Quality of the equipment and materials	15 (53.6)	12 (42.9)	1 (3.6)	19 (41.3)	22 (47.8)	4 (8.7)
Technology available for diagnosis	21 (75.0)	3 (10.7)	4 (14.3)	37 (80.4)	4 (8.7)	5 (10.9)
Promptness in diagnosis	23 (82.1)	3 (10.7)	2 (7.1)	29 (63.0)	8 (17.4)	9 (19.6)
Adequacy of the service	23 (82.1)	3 (10.7)	1 (3.6)	17 (37.0)	21 (45.7)	6 (13.0)
Resolutivity	23 (82.1)	2 (7.1)	2 (7.1)	26 (56.5)	9 (19.6)	10 (21.7)

location_on

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

rss_feed Acompañe los números de esta revista en su lector de RSS

[TFN1] SAMU: mobile emergency care service; IQR: interquartile range.

[TFN2] ^*
Comparison of the time since graduation between physicians of level II hospitals and level III/IV hospitals: p ≤ 0.01;

[TFN3] ^†
Comparison of the time since graduation between SAMU and non-SAMU physicians: p = 0.64;

[TFN4] ^‡
Two physicians had multiple specialties: one had two specialties (Internal Medicine and Surgery) and the other, three (Anesthesiology, Gynecology and Obstetrics, Labour Medicine). Both worked at a level III/IV hospital;

[TFN5] ^§
Others: Anesthesiology (3, 1 at SAMU and 2 at level III/IV hospital), Cardiovascular Surgery (2, at SAMU), Thoracic Surgery (2, 1 at SAMU and 1 at level III/IV hospital), Intensive Care Medicine (2, 1 at SAMU and 1 at level III/IV hospital), Neurology (1, at level II hospital), Dermatology (1, at level II hospital), Traffic Medicine (1, at SAMU), Labour Medicine (2, at level III/IV hospital), Orthopedics and Traumatology (1, at level III/IV hospital) and Psychiatry (1, at level III/IV hospital).