ABSTRACT

The aim of this study was to evaluate the satisfaction of the users assisted by the Mobile Emergency Care Service of the state of Rio Grande do Norte. It is a transversal, analytical and quantitative research, carried out from January to June of 2016, with 384 users. Satisfaction was obtained in structure and process. The indicator of structure that generated more dissatisfaction was the comfort of ambulances, and of the process was the response time. It is concluded that users are, mostly, satisfied with the state service, however, user satisfaction surveys are always necessary for the constant monitoring of this service.

KEYWORDS
Patient satisfaction; Prehospital care; Health evaluation; Patient-centered care

Introduction

The satisfaction of the user can be conceptualized as a relation between the expectations and perceptions of the user about the care received by a health service, which demonstrates the cognitive and affective evaluation of that according to previous experience¹1 Inchauspe JAF, Moura GMS. Aplicabilidade dos resultados da pesquisa de satisfação dos usuários pela Enfermagem. Acta Paul Enferm [internet]. 2015 [acesso em 2016 jan 14]; 28(2):177-182. Disponível em: http://www.scielo.br/pdf/ape/v28n2/1982-0194-ape-28-02-0177.pdf.
http://www.scielo.br/pdf/ape/v28n2/1982-... .

The practice of evaluating the quality of health services through a survey of users has spread since the 1970s, in Europe and the United States, with the objective of achieving better clinical results through adherence to treatment, in three dimensions: attendance at consultations; acceptance of recommendations and prescriptions; and adequate use of medicines²2 Dantas RAN, Torres GV, Salvetti MG, et al. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation. Rev Esc Enferm USP [internet]. 2015 [acesso em 2016 set 4]; 49(3):381-387. Disponível em: http://www.scielo.br/pdf/reeusp/v49n3/pt_0080-6234-reeusp-49-03-0381.pdf.
http://www.scielo.br/pdf/reeusp/v49n3/pt... .

With the quality model proposed by Donabedian³3 Donabedian A. La calidad de la atención médica. Definición y métodos de evaluación. Mexico: La Prensa Médica Mexicana; 1984., the evaluation of user satisfaction was added to the evaluation elements of the quality of health services, along with the evaluation of the doctor and the community. The quality began to be observed from these three angles, in a complementary way and, at the same time, independent. The quality concept developed by Donabed³3 Donabedian A. La calidad de la atención médica. Definición y métodos de evaluación. Mexico: La Prensa Médica Mexicana; 1984. allowed us to move forward to incorporate non-specialists (users) in the definition of parameters and in the measurement of the quality of the services.

The satisfaction of the users is a way of evaluating the quality of service and care, whose information can be used to analyze the structure offered, the processes performed and the results achieved¹1 Inchauspe JAF, Moura GMS. Aplicabilidade dos resultados da pesquisa de satisfação dos usuários pela Enfermagem. Acta Paul Enferm [internet]. 2015 [acesso em 2016 jan 14]; 28(2):177-182. Disponível em: http://www.scielo.br/pdf/ape/v28n2/1982-0194-ape-28-02-0177.pdf.
http://www.scielo.br/pdf/ape/v28n2/1982-... .

In Brazil, surveys about the satisfaction of the user in the evaluation of health services, as part of planning and evaluation processes, became more common in the second half of the 1990s, with the consolidation of social control in the sphere of the Unified Health System (SUS) and with the participation of the population in the evaluation and planning course⁴4 Paes NA, Silva CS, Figueiredo TMRM, et al. Satisfação dos usuários hipertensos com os serviços da rede de atenção primária no Brasil: um estudo de validação. Rev Panam Salud pública [internet]. 2014 [acesso em 2016 set 9]; 36(2):87-93. Disponível em: http://www.scielosp.org/pdf/rpsp/v36n2/03.pdf.
http://www.scielosp.org/pdf/rpsp/v36n2/0... .

In this sense, the Country has been presenting advances in policies that attempt to restructure and qualify health services. Among them, the National Program for the Evaluation of Health Services (PNASS) emerged, which originated in 2004, based on the expansion of the National Program for Evaluation of Hospital Services (PNASH), with the objective of evaluating the totality of health services which benefited from financial resources derived from programs, policies and incentives of the Ministry of Health to invest in the following areas: structure, process, result, care production, risk management and user satisfaction in relation to the care received from health services⁵5 Brasil. Ministério da Saúde. Programa Nacional de Avaliação de Serviços de Saúde PNASS [internet]. Brasília, DF: MS; 2015 [acesso em 2016 set 9]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pnass_programa_nacional_avaliacao_servicos.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe... .

In many countries, especially in developing countries, the urgency and emergency sectors are identified as deficient and problematic areas within the health system, in which the guidelines for decentralization, regionalization and hierarchy are little implemented, attending beyond its installed capacity, which represents a serious and relevant health system problem, especially in developing countries. The progressive worsening of this situation amplifies the discussions about the factors related to the chaotic situation of emergency care in Brazil⁶6 Silva NC, Nogueira LT. Avaliação de indicadores operacionais de um serviço de atendimento móvel de urgência. Cogitare enferm. [internet]. 2012 [acesso em 2016 set 11]; 17(3):471-477. Disponível em: http://revistas.ufpr.br/cogitare/article/viewFile/29287/19037.
http://revistas.ufpr.br/cogitare/article... ^,77 Morais AS, Melleiro MM. A qualidade da assistência de enfermagem em uma unidade de emergência: a percepção do usuário. Rev Eletrônica Enferm [internet]. 2013 [acesso em 2016 set 1]; 15(1):112-120. Disponível em: http://www.revistas.ufg.br/fen/article/view/15243.
http://www.revistas.ufg.br/fen/article/v... .

The Emergency Mobile Care Service (Samu), as an authorizing service of assistance in emergency cases, is not outside this reality. The professionals working in these services experience lack of materials, lack of safety, financial limitations, insufficient provision of training for the teams, and stressful factors during the process of assisting victims in different situations, whether clinical or traumatic²2 Dantas RAN, Torres GV, Salvetti MG, et al. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation. Rev Esc Enferm USP [internet]. 2015 [acesso em 2016 set 4]; 49(3):381-387. Disponível em: http://www.scielo.br/pdf/reeusp/v49n3/pt_0080-6234-reeusp-49-03-0381.pdf.
http://www.scielo.br/pdf/reeusp/v49n3/pt... .

Among the various components of the health system in the world, urgency and emergency services were considered as a priority in the qualification process, as they were recognized as one of the main sources of complaints by the population. International studies bring the implementation of a structured network of emergency and use of ambulances with remote medical regulation as axes that can minimize this phenomenon⁸8 Melon KA, Branco DE, Rankin J. Beat the clock! Wait times and the production of quality in emergency departments. Nurs philos [internet]. 2013 [acesso em 2016 set 4]; 14(3):223-237. Disponível em: http://onlinelibrary.wiley.com/doi/10.1111/nup.12022/ful.
http://onlinelibrary.wiley.com/doi/10.11... ^,99 Finn JC, Fatovich DM, Arendts G, et al. Evidence-based paramedic models of care to reduce unnecessary emergency department attendance - feasibility and safety. BMC emerg med [internet]. 2014 [acesso em 2016 set 4]; 13(13):1-6. Disponível em: https://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-13-13.
https://bmcemergmed.biomedcentral.com/ar... .

In this way, this study is relevant, since it is believed that this evaluation may contribute to the creation of managerial strategies in order to enhance the quality of care. Moreover, the fact that, so far, few published studies that deal with this subject in the Country have been found to have stimulated its execution. Therefore, this study aims to: evaluate the satisfaction of users served by a Pre-hospital Emergency Mobile Service in the state of Rio Grande do Norte.

Methods

This is a cross-sectional research, analytical, with quantitative approach. Data were collected at the Monsenhor Walfredo Gurgel Hospital Complex (HMWG), specifically, at the Clóvis Sarinho Emergency Room (PSCS), after the service and stabilization of the users by the Samu and HMWG/PSCS professionals.

Samu serves about 800 users per month, therefore, it is estimated that this service makes about 9600 attendances per year. For the calculation of the sample¹⁰10 Barbetta PA. Estatística aplicada às ciências sociais. 8. ed. Florianópolis: Universidade Federal de Santa Catarina; 2013., a sampling error of 5% was considered. The sample consisted of 384 users served by Samu, according to the following eligibility criteria: age equal to or greater than 18 years old; and, in the case of coma, mental confusion, impossibility of verbal communication or death, be with legally responsible companions to sign the Informed Consent Term (ICF). Users and/or companions who did not have the cognitive conditions to answer the questionnaire were excluded.

For data collection, the instrument already validated by specialists was used, entitled Instrument of Evaluation of Satisfaction of users attended by Prehospital Care (AS-APH)¹¹11 Cavalcanti RL, Dantas DV, Martiniano DWL, et al. Avaliação da satisfação de usuários atendidos em serviços pré-hospitalares móveis de emergência: validação de instrumento. Nursing (São Paulo) [internet]. 2017 [acesso em 2018 jan 4]; 20(230):1796-1800.. The instrument used contains personal data (gender, age, origin and level of education), type of occurrence (traumatic or clinical) and 12 indicators of user satisfaction, of which 4 are structure (ambulance maintenance status, user comfort (access, privacy, humanization, guidelines on procedures, relationship between user and team, response time, multi-professional articulation and resolving service), as shown in chart 1.

Data collection was performed from January to June 2016. The approach of the patients was based on convenience, in the morning, afternoon and evening shifts, every day of the week. For this data collection, it was necessary the contribution of 12 students of scientific initiation, members of the Research Group Nucleus of Studies and Research in Urgency, Emergency and Intensive Therapy (Nepet), under the guidance of the researchers. Training was conducted for guidance on user approach and collection itself.

For the performance of the descriptive and inferential statistical treatment, it was necessary to categorize the variables in two ways. Firstly, the responses for each indicator were presented as a Likert type scale, in five levels: terrible; bad; regular; good; and excellent. In the analysis of the data, the answers: terrible, bad and regular were considered as a new qualitative variable for 'unsatisfied', while good and excellent, for 'satisfied', referring to the assessment of the quality of care provided, in the vision of users.

In addition, the new variables were classified into quantitative categories for the structure and process indicators. For each item considered appropriate, a point was assigned. As the instrument contained 4 structural items and 8 process items, the total structure dimension ranged from 0 to 4, and the total process dimension ranged from 0 to 8. The total scale varied from 0 to 12. In this configuration, it was considered that cases of the structure dimension would be considered 'satisfied' if they obtained score ≥ 3; the cases with punctuation <3 were considered 'unsatisfied'; in the process dimension, would be considered 'satisfied' if they scored ≥ 6; and cases with a score <6 were considered 'unsatisfied'. When analyzing the structure and process dimensions together, it was considered that the user would be 'satisfied' for scores ≥ 9 and 'unsatisfied' for scores <9, based on the National Health Services Assessment Program⁵5 Brasil. Ministério da Saúde. Programa Nacional de Avaliação de Serviços de Saúde PNASS [internet]. Brasília, DF: MS; 2015 [acesso em 2016 set 9]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pnass_programa_nacional_avaliacao_servicos.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe... (chart 2).

The data collected were double-typed in the Microsoft Excel program and, then, imported into the SPSS program (version 20.0 for Windows), in which they were tabulated and analyzed from descriptive and inferential statistics and presented as tables.

Assuming that the research involved human beings, it followed Resolution nº 466/2012 of the National Health Council¹²12 Conselho Nacional de Saúde (Brasil). Resolução n°466, de 12 de dezembro de 2012. Normas para pesquisa envolvendo seres humanos. Diário Oficial da União. 12 Dez 2012.. In addition, it was pointed out that prior authorization was obtained from the institution for data collection, and that the study was approved by the Research Ethics Committee of the Onofre Lopes University Hospital (HUOL), in Natal (RN), obtaining a favorable opinion, CAAE: 0025.0.294.051-10.

Results

With regard to personal characterization, the majority of users were male: 249; the age of users ranged from 18 to 101 years old, with an average of 52.14 (23.4%); as to origin, 219 (57%) lived in the state capital, and 158 (41.1%) in the interior of the state; and in relation to the level of schooling, the complete high school reached the highest percentage, with 82 (21.4%) of the users.

Regarding the type of occurrence of the visits performed by Samu, in the period from January to June 2016, there was a higher prevalence of traumatic events, 225 (58.6%), and 159 (41.4%) of clinical causes.

The evaluation of the quality indicators showed that the comfort item inside the ambulance had satisfaction of 85.2%, which differs from the other indicators, that present a satisfaction of more than 90%. The process items show that two indicators, multi-professional articulation and time response, had satisfaction lower than 86%, which also differs from other indicators, that present a satisfaction of more than 90% (chart 3).

There was no statistically significant difference between the event suffered in the evaluation of the quality of the indicators of satisfaction of structure and process, that is, the majority of users who suffered traumatic and clinical events were satisfied with the structure. Regarding the process, there was also no significant difference. The joint analysis of structure and process also did not indicate a significant statistical difference between the event occurred. For the most part, users were satisfied with the service provided by Samu (table 1).

In the evaluation of the average scores, it is noticed that the users are satisfied with the structure, since the averages were superior to three, regardless of the event suffered. In relation to the process, the averages were above seven, indicating satisfaction of the users. In the joint evaluation of structure and process, the averages were above nine, regardless of the event occurred (chart 4).

Discussion

The personal characteristics of the users served by Samu reinforce another research conducted in Brazil, regarding the sex of the users served. A study carried out in Samu found that, of the 3.186 occurrences, there was a predominance of males. They were 2.012 (63.2%), while the female sex presented 1.140, that is, 35.8% of the cases attended¹³13 Dias JMC, Lima MSM, Dantas RAN, et al. Perfil de atendimento do Serviço Pré-Hospitalar Móvel de Urgência Estadual. Cogitare enferm [internet]. 2016 [acesso em 2016 set 4]; 21(1):1-9. Disponível em: http://docs.bvsalud.org/biblioref/2016/07/706/42470-171307-1-pb.pdf.
http://docs.bvsalud.org/biblioref/2016/0... .

Regarding the age group, in a survey about the epidemiological clinical profile of the users of the Emergency Network in the interior of Pernambuco, it can be seen that the age ranged from 30 to 39 years old, the latter being the most representative, with 31% of the entire population sample. Immediately afterwards the interval between 40 and 49 years appears, with 26%¹⁴14 Oliveira ANS, Lima KSB, Moura LA, et al. O perfil clínico epidemiológico dos usuários da rede de urgências no interior de Pernambuco. Rev pesqui cuid fundam [internet]. 2013 [acesso em 2016 set 1]; 5(2):3601-3607. Disponível em: seer.unirio.br/index.php/cuidadofundamental/article/download/2006/pdf_729.
seer.unirio.br/index.php/cuidadofundamen... .

Regarding the level of education of users, in the investigation of the epidemiological clinical profile of the users of the Emergency Network in the interior of Pernambuco, carried out with 119 users, most had a complete high school education (67%)¹⁴14 Oliveira ANS, Lima KSB, Moura LA, et al. O perfil clínico epidemiológico dos usuários da rede de urgências no interior de Pernambuco. Rev pesqui cuid fundam [internet]. 2013 [acesso em 2016 set 1]; 5(2):3601-3607. Disponível em: seer.unirio.br/index.php/cuidadofundamental/article/download/2006/pdf_729.
seer.unirio.br/index.php/cuidadofundamen... .

When analyzing the type of occurrence, a study carried out in the same state, in 2014, which analyzed 3.186 occurrences of the mobile prehospital emergency service, showed that 1.473 (46.2%) occurrences attended by the service referred to clinical causes, and 1.454 (45.6%) to traumatic¹³13 Dias JMC, Lima MSM, Dantas RAN, et al. Perfil de atendimento do Serviço Pré-Hospitalar Móvel de Urgência Estadual. Cogitare enferm [internet]. 2016 [acesso em 2016 set 4]; 21(1):1-9. Disponível em: http://docs.bvsalud.org/biblioref/2016/07/706/42470-171307-1-pb.pdf.
http://docs.bvsalud.org/biblioref/2016/0... . These numbers differ from the data found in this research. Data collection occurred at a referral hospital for trauma in the state, and this finding was expected.

Analyzing, descriptively, the results related to the structure, it is stressed the positive evaluation of the users, regardless of the type of event suffered, in relation to the safety demonstrated by the professionals, the reception and the state of conservation of the ambulances.

The safety demonstrated by the professional team is a factor that determines the satisfaction of the user assisted by the emergency service, being related to the emotional, technical and social skills of the professionals, who, in emergency situations, will provide a decrease in the level of anxiety patient who is in a context of strong emotional impact due to the fragility of their situation¹⁵15 Baubin M, Neumayr A, Eigenstuhler J, et al. Patient satisfaction in out-of-hospital emergency care. Notf Rett Med [internet]. 2012 [acesso em 2016 set 22]; 3(1):225-233. Disponível em: https://link.springer.com/article/10.1007/s10049-011-1466-4.
https://link.springer.com/article/10.100... .

The state of preservation of the ambulance helps in the care provided by the professionals to the patients, and may lead to inadequate assistance to the user, which may reflect their degree of satisfaction¹⁶16 Booker MJ, Shaw ARG, Purdy S. Why do patients with 'primary care sensitive' problems access ambulance services? A systematic mapping review of the literature. BMJ Open [internet]. 2015 [acesso em 2016 set 24]; 1(5):1-10. Disponível em: http://bmjopen.bmj.com/content/5/5/e007726.
http://bmjopen.bmj.com/content/5/5/e0077... .

Despite the satisfaction of the users with structural aspects in general, the user comfort indicator within the ambulance was less satisfactory (85%). Research in New Zealand confirms this finding, demonstrating that 83% of the users served by the prehospital service are satisfied with the comfort offered, as it provides a sensation of relaxation and reduces anxiety¹⁷17 Swain AH, Al-Salami M, Hoyle SR, et al. Patient satisfaction and outcome using emergency care practitioners in New Zealand. Emerg Med Australas [internet]. 2012 [acesso em 2016 set 24]; 24(2):175-180. Disponível em: http://www.wfa.org.nz/file/454/UCC-satisfaction---printed.pdf.
http://www.wfa.org.nz/file/454/UCC-satis... .

In the analysis of process indicators, the users of this study, in general, are also satisfied with the service offered. The process indicators that obtained the best evaluation were: privacy, resolution in service, humanization, relationship between user and team, orientation about procedure and access to the service.

Research carried out in Austria reveals that the users attended by the prehospital care service are satisfied with the privacy during the execution of the procedures performed by the team¹⁵15 Baubin M, Neumayr A, Eigenstuhler J, et al. Patient satisfaction in out-of-hospital emergency care. Notf Rett Med [internet]. 2012 [acesso em 2016 set 22]; 3(1):225-233. Disponível em: https://link.springer.com/article/10.1007/s10049-011-1466-4.
https://link.springer.com/article/10.100... .

In a study with patients suspected of fracture, the procedures performed at the event site were very significant for the users; the dialogue and the relationship between professionals and users has created a relationship of well-being in the vision of the users; humanization was well evaluated¹⁸18 Aronsson K, Bjorkdahl I, Sundström BW. Prehospital emergency care for patients with suspected hip fractures after falling - older patients' experiences. J Clin Nurs [internet]. 2014 [acesso em 2016 set 24]; 23(21-22):3115-3123. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24476341.
https://www.ncbi.nlm.nih.gov/pubmed/2447... .

According to investigation, 50% of the general satisfaction of the user with the service provided is dependent on the relationship of the patient with the team that attends to him/her¹⁹19 Donabedian A. La qualitadell' assistenza sanitária. Roma: NIS; 1990.. The relationship between professional and user refers to the recognition of the subject in an integral and holistic way, where the user is taken into account in their biological aspects, beliefs and values, with consequent benefit to the establishment of a relation of respect, as well as in the taking of care decisions, between professionals and users²⁰20 Schimith MD, Simon BS, Brêtas ACP, et al. Relações entre profissionais de saúde e usuários durante as práticas em saúde. Trab educ saúde [internet]. 2011 [acesso em 2016 set 4]; 9(3):479-503. Disponível em: http://www.scielo.br/pdf/tes/v9n3/v9n3a08.pdf.
http://www.scielo.br/pdf/tes/v9n3/v9n3a0... .

The process indicators with less satisfactory evaluation were: response time (80.9) and multi-professional articulation.

A study by Shankar, Bhatia and Schuur²¹21 Shankar KN, Bhatia BK, Schuur JD. Toward patient-centered care: a systematic review of older adults' views of quality emergency care. Ann Emerg Med [internet]. 2014 [acesso em 2016 set 24]; 63(5):529-550. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24051211.
https://www.ncbi.nlm.nih.gov/pubmed/2405... on the satisfaction of elderly patients with mobile emergency service found that the shorter waiting time, the better the service is evaluated by the users. Users value the rapid response of an ambulance in the scene, whether they are in an emergency or not. Even if the waiting time is short, for the user, it is a long time because he/she is in a state of panic²²22 Moura LRM, Rocha ESB, Moura MEB, et al. of family health strategy users on emergency service. Rev. pesqui cuid fundam [internet]. 2013 [acesso em 2016 set 5]; 5(6):169-186. Disponível em: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/3445.
http://www.seer.unirio.br/index.php/cuid... ^,2323 Togher FJ, O'Cathain A, Phung VH, et al. Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study. Health Expect [internet]. 2015 [acesso em 2016 set 3]; 18(6):2951-2961. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25303062.
https://www.ncbi.nlm.nih.gov/pubmed/2530... .

Researches affirm that the transportation of the patient to the appropriate service directly influences his/her satisfaction with the service, thus providing continuity of care and its resolution²⁴24 Prada EEP, Domínguez NM, Domínguez AM, et al. Satisfacción com el funcionamento del Sistema Integrado de Urgencias Médicas enlaprovincia de Guantánamo. Medisan [internet]. 2011 [acesso em 2016 set 3]; 15(6):820-827. Disponível em: http://scielo.sld.cu/pdf/san/v15n6/san13611.pdf.
http://scielo.sld.cu/pdf/san/v15n6/san13... ^,2525 Miranda JJ, Rosales-Mayor E, Quistberg DA, et al. Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study. F1000Res [internet]. 2013 [acesso em 2016 dez 23]; 2(167):1-12. Disponível em: https://f1000research.com/articles/2-167/v1.
https://f1000research.com/articles/2-167... . The transport of the patient to a hospital that presents problems of overcrowding may have influenced the negative evaluation of this indicator.

In the joint evaluation of the structure and the process, it was noticed that the users are satisfied with the service offered by Samu of the state of Rio Grande do Norte, with a general average of 10.97.

According to the study, it is possible to highlight the social and welfare function of Samu, since its intervention guides and informs the user, anticipates care by the rescue teams and establishes diagnosis early, having resolution at the scene or removing the user to a door of urgency in a secure and agile way, which is recognized by users. The choice of the patient by the emergency services is based on the expectation of fast, safe and more reliable care²⁶26 Abreu KP, Pelegrinib AHW, Marques GQ, et al. Percepções de urgência para usuários e motivos de utilização do serviço de atendimento pré-hospitalar móvel. Rev gaúch enferm [internet]. 2012 [acesso em 2017 jun 23]; 33(2):146-156. Disponível em: http://www.scielo.br/pdf/rgenf/v33n2/21.pdf.
http://www.scielo.br/pdf/rgenf/v33n2/21....

27 Sarmento DGS, Dantas RAN, Dantas DV, et al. Profile of individuals with neurological disorders assisted by a prehospital mobile emergency care service. Cogitare enferm [internet]. 2017 [acesso em 2017 jun 28]; 22(2):1-8. Disponível em: http://dx.doi.org/10.5380/ce.v22i2.49698.
http://dx.doi.org/10.5380/ce.v22i2.49698... ^-2828 Dantas RAN, Dantas DV, Salvetti MG, et al. Quality of care indicators of a prehospital mobile emergency. International Archives of Medicine [internet]. 2016 [acesso em 2016 dez 30]; 9(302):1-9. Disponível em: https://imed.pub/ojs/index.php/iam/article/view/1848/1884.
https://imed.pub/ojs/index.php/iam/artic... .

Conclusions

It was verified that the users are satisfied with the assistance provided by Samu of the state of Rio Grande do Norte in the structure and process dimension. With regard to the overall average of the structure and process evaluation, together, users, regardless of the event suffered, are also satisfied.

Despite the overall satisfaction, the structure indicator that generated the most dissatisfaction was the comfort of the ambulances, and the process was the response time, showing fragile items, that need to be better restructured in the service under analysis.

Given this analysis, it can be observed that, despite all the challenges and difficulties experienced by Samu, the professionals are managing to provide adequate assistance to the population. It is a service that has come to standardize and regulate a fundamental life-saving service, with proven effectiveness.

As a limitation of this study, it is stressed the need to elaborate almost experimental studies on this subject, when a non-participant observer should analyze in real time the structure and process indicators inside the ambulance, in the act of urgent assistance. However, this experience has not yet been possible due to the reduced internal space of the ambulances, which may make it difficult to carry out emergency care for the users.

Despite this limitation, it is believed that the study can be replicated in other brazilian cities and states, since the AS-APH instrument used was validated by experts in the field.

It is evident the need for more studies that address this issue, so that the opinion of the user about the service being offered can be known, enabling a better understanding of their needs and demands by the health services.

References

Publication Dates

History