ABC | Volume 111, Nº2, August 2018

Original Article Marcolino et al Satisfaction of emergency physicians Arq Bras Cardiol. 2018; 111(2):151-159 (median 2.5, IQR 2.0‑3.5) was observed as compared to “satisfaction with the care provided ” (median 2.0, IQR 2.0‑4.0). In the domain “satisfaction with the care provided ”, a significant difference was observed between the groups regarding technical support , perceived as worse by the hospital physicians. In the domain “structure of care and diagnosis” , the satisfaction of the hospital physicians with “medical facilities for the diagnosis of cardiovascular diseases” , “promptness in diagnosis” , “adequacy of the service” and “resolutivity” was lower as compared to that of SAMU physicians. In addition, the satisfaction of physicians of level II hospitals with those same items was lower than that of physicians of level III/IV hospitals. The satisfaction with the “technology available for diagnosis” was lower among the hospital physicians as compared to that of SAMU physicians, but did not differ between the two subgroups of hospital physicians. When comparing SAMU physicians with those working at hospital emergency services, the former showed a higher satisfaction level in both domains (Figure 1, Table 3). When comparing physicians working at level II hospitals with those at level III/IV hospitals, the satisfaction with the care provided was similar. However, when assessing the domain “structure of care and diagnosis” , the physicians working at level III/IV hospitals were more satisfied (Figure 2, Table 4). Discussion This study involved physicians working in the public emergency services of the Northern Region of Minas Gerais (SAMU and emergency units of hospitals of different levels of complexity). Most of them had a short time since graduation, were male and specialists (68.6%). In addition, most of them expressed overall dissatisfaction with the care provided to cardiovascular diseases. SAMU physicians expressed higher level of satisfaction with the structure of cardiovascular care as compared to those working at the regional hospitals. In both groups, most physicians were satisfied with the “ technical support” for the management of a patient, while most SAMU physicians were dissatisfied with the “ care provided” and “ technology available for diagnosis” (54% for both), and most hospital physicians were dissatisfied with the “ technology available for diagnosis” (78.4%) and “ promptness in diagnosis”  (70.3%). The health system of the Northern Region of Minas Gerais is a hierarchical regional emergency care network. 13 Oliveira et al. 18 have reported that the health system would be better considered as a circuit with multiple entry points, in which there is a more suitable place for each patient regarding the required type of care. When referring a patient to an emergency service, SAMU regulatory center physicians should always consider the best option regarding Table 2 – Comparison of the satisfaction of physicians (CARDIOSATIS-Team scale) categorized according to the type of emergency service, and result of the comparison test between groups Domains/Itens of the scale Overall (n = 137) Non-SAMU (n = 74) SAMU (n = 63) Comparison between SAMU and non-SAMU (p-value)* 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)* 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 Values expressed as median (interquartile range), except when indicated; * Comparative analysis by use of Mann-Whitney U test. 154