| Summary: | 碩士 === 長榮大學 === 醫務管理學系(所) === 98 === Purpose: The purpose of this study is to investigate the primary care physicians’ experiences of reporting notifiable diseases, cognition of disease reporting, concept and attitude of disease reporting, and factors affecting their unreporting and reporting choices.
Method: The subjects were general clinic physician in Taiwan, and mainly from divisions of general medicine, family medicine, obstetrics and gynecology, otolaryngology, pediatrics, and urology. Random sampling was conducted upon the list of clinics announced by the Department of Health. The questionnaire survey was conducted by assigned interviewers from July to August, 2006. A total of 1,250 questionnaires were expected to be completed, and the completion rate was 87.44%. The content of the questionnaire included: basic information of primary care physicians, past reporting experiences, and their awareness and cognition of reporting.
Results: Most of the subjects are male (86.9%), have practiced medicine for more than one decade (55.9%), and are regarded as experienced physicians. Older physicians have more experiences in reporting (43.8%,p =.005). Among all subjects, 406 physicians have diagnosed notifiable diseases during their medical practice at primary medical institutions (37.2%); and among those, 334 physicians have reported notifiable diseases (83.5%), while 66 physicians (16.5%) have never reported them. The main reasons for the unreporting include fear of violating patient privacy (32.8%), complicated reporting procedure (31.1%), or suggesting it unnecessary to report the diseases because the patient had received the treatment. Approximately 30% of the physicians still suggest that the current reporting method is inconvenient or difficult to understand (32.8%). In the past, most physicians reported notifiable diseases by faxing the report lists to the county (municipal) bureau of public health (65%); at present, more than half of them (57.0%) indicate that it is more convenient to use telephone for reporting. They suggest that the simplification of reporting procedure (73.7%) and the provision of instantaneous disease condition feedback information (42.2%) can most increase the willingness to report diseases. Among all the notifiable diseases, the disease of the lowest cognition accuracy rate is varicella (28.2%), followed by tetanus (29.6%), measles (39.7%), and rubella (40.1%). In terms of attitude, the physicians concern about the reporting of notifiable diseases (χ2=11.54,p =.001) and those who would ask the clinical nurses to assist in the completion of reporting (χ2=13.73,p =.000) have more positive attitude and higher willingness to report diseases. However, they suggest that the current reporting procedure is time-consuming and they tend to forget to report the diseases because they are busy (χ2=10.68,p =.001). When confronting milder symptoms (χ2=14.51,p =.000) or diseases which are hard to be diagnosed (χ2=5.65,p =.017), their willingness to report them is lower, which indirectly affects their decision of disease reporting.
Conclusions: Many unknown infectious diseases may further arise in the future, which not only affects national health, but also challenges the adaptability of medical and health systems. Therefore, the basic prevention method is to put “Notifiable Diseases Reporting System” into practice. Rapid reporting and instantaneous control of disease condition are the best method to protect national health. It is hoped that this study could help continuously improving the notifiable diseases reporting system to construct a more complete health protection network for national health. Several suggestions are proposed as follows: 1) simplify the reporting procedure; 2) regularly hold notifiable diseases reporting training activities; 3) train nursing staff to assist in the reporting of notifiable diseases; 4) regularly provide primary clinics with health education leaflets and reporting procedure posters of each kind of notifiable diseases; 5) construct the instantaneous reply system for the reporting of notifiable diseases.
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