愛滋病風險、醫師的臨床防護及照護意願

Aids Risk, Physicians' Clinical Precautions and Willingness to Treat Aids Patients

丁志音(Chin-Yin Lew-Ting) ； 涂醒哲(Shiing-Jer Twu)

《中華公共衛生雜誌》 16卷3期 (1997/06) Pp. 231-243

https://doi.org/10.6288/CJPH1997-16-03-05

摘要

風險已成為愛滋病防治與照護中的主流觀念。本研究旨在探討愛滋病相關風險對醫師的防護行為及照護意願的影響。研究資料得自一全國性的郵寄問卷調查，最終之研究樣本包括1702名年齡70歲以下之西醫師，回覆率為24.3%。本研究之主要核心變項為「風險特質」－即愛滋病相關風險，共包含三個層面：臨床或職業風險、愛滋病風險評量、以及自覺被感染風險。主要研究結果為：(1)自覺感染風險相當程度的受到臨床風險及愛滋病風險評量的影響。在醫院服務之醫師的臨床風險及自覺感染愛滋病之風險均高於開業醫師，且年齡愈輕者愈如是，(2)高達80.8%的醫師擔心自己在照護愛滋病患時受到感染，其和愛滋病風險評量及自覺被感染風險之相關較強，但與實際臨床風險的相關較弱，(3)無論就防護行為或照護意願而言，愛滋病風險評量皆為三個風險變項中最具影響力者，而影響力最弱者仍為臨床風險。因此，主觀的風險知覺對醫師的心理狀況及行為意向遠比客觀的實際臨床風險來得重要。為了舒緩醫師對愛滋病的恐慌並增強其照護意願，除加強敎育及訓練以期能掌握相關的風險狀況之外，更應強調合宜的風險溝通，並能提供防護設備，鼓勵其採取必要的防護措施。

關鍵字

愛滋病 ； 風險 ； 防護行為 ； 照護意願

並列摘要

Risk has emerged as a main concept in AIDS prevention, control, and providing care to those who were HIV-infected. This study concerns the impact of risk on the physicians' willingness to treat People with AIDS (PWAs) and adopting precautions in the course of AIDS clinical work. Data for this study came from a mailed survey of a national representative random sample of active physicians. A total of 1702 physicians participated in this study, which resulted in a response rate of 24.3%. The core construct of this study ”AIDS-related risk” is conceptualized into three aspects of risk characteristics: (1) clinical/occupational risk, (2) AIDS risk assessment, and (3) perceived risk of infection. The major findings are: (1) Clincial risk and AIDS risk assessment can predict a substantial proportion of variability of perceived risk of infection. Compared with physicans working in private clinics, hospital/medical center physicians were at a greater exposure of clinical risk and higher in perceived risk of infection, which is especially the case among younger physicians, (2) While as many as 80.8% physicians worried about contagion in providing care to PWAs, both AIDS risk assessment and percieved risk of infection, rather than clinical risk, had much stronger correlation with worry, and (3) Among three AIDS-related risk variables, AIDS risk assessment is the most powerful predictors of both willingness to provide care and precautions adoption, and clinical risk the least. The results suggest that subjective risk perception plays a much more important role than objective risk in translating worry/fear into behavioral intentions. To assure that our health care system manages HIV disease effectively, interventions need to bring about changes in physicians' perception of risk, and, even more importantly, their ability to undertake infection control measures against HIV transmission.

並列關鍵字

AIDS ； risk ； clinical precautions ； willingness to treat PWAs