影響基層醫師法定傳染病通報之相關因素探討

Discussion on Related Factors Affecting the Reporting of Notifiable Infectious Diseases by Primary Care Physicians

黃詩婷(Shih-Ting Huang)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2010年)

摘要

目的：探討基層醫療院所醫師的法定傳染病通報經驗、對通報疾病的認知、對疾病通報的觀念態度及未進行通報和影響通報的原因。
方法：本研究對象為全省一般開業診所醫師，科別選擇以一般內科、家庭醫學科、婦產科、耳鼻喉科、小兒科、泌尿科為主，利用衛生署公告診所名單進行隨機抽樣後，再於95年7月至8月間派遣訪員進行問卷調查，預計完成1,250份，問卷完成率為87.44%。問卷內容包含：基層醫師基本資料、過去通報的經驗及通報的認知與態度。
結果：研究樣本男性比率較高，佔總樣本數的86.9%。多具有十年以上執業年資(55.9%)，判斷為已有相當看診經驗之醫師群，且年齡越高越具有通報之經驗(43.8%,p =.005)。曾經在基層醫療院所服務期間診斷過法定傳染病的醫師有406位，佔總樣本數的37.2%；在這之中，表示曾經通報法定傳染病的醫師有334位(83.5%)，沒有通報的有66位(16.5%)。他們未進行通報的原因，主要是怕侵犯病人隱私(32.8％)、感覺通報手續麻煩(31.1％)或者是認為病人已經接受治療，不需要通報(24.6％)。目前的通報方式，仍有3成的人覺得不方便或不明瞭(32.8%)。過去大多數的醫師利用傳真報告單至縣(市)衛生局做通報 (64.5%)，現在超過半數(57.0%)的人表示最想利用電話人工通報較為便利，且表示簡化通報流程和有即時的疫情回饋，最能提高通報意願(73.7%;42.2%)。法定傳染病認知正確率最低的是水痘(28.2%)，其次依序為破傷風(29.6%)、麻疹(39.7%)以及德國麻疹(40.1%)。在態度方面，本身重視法定傳染病通報工作(χ2=11.54,p =.001)及會要求診所護士協助完成通報(χ2=13.73,p =.000)的醫師，觀念較正向且通報意願較高；但他們認為現在的通報流程太花費時間，常常會因忙碌而忘記通報(χ2=10.68,p =.001)；若在面對病症較輕微(χ2=14.51,p =.000)或較難確立診斷的疾病(χ2=5.65,p =.017)則通報意願會更低，間接影響醫師通報的決定。
結論：未來可能還會有許多未知的新興傳染病出現，不僅會侵襲全民健康也考驗著醫療衛生體系應變的能力。所以，落實「法定傳染病通報系統」為基本之防範方式，透過快速的通報即時控制疫情，是保障全民健康最好的方法。本研究期待法定傳染病通報系統能持續改進，為全民建構更完善之健康防護網，在此提供幾項建議：1.簡化通報流程2.定期舉辦法定傳染病通報研習訓綀、講習或是再教育訓綀3.培訓護理人員協助法定傳染病通報工作4.固定提供基層診所各類法定傳染病衛教單及通報流程海報5.建立法定傳染病通報即時回覆系統。

關鍵字：法定傳染病、傳染病通報、通報經驗

關鍵字

法定傳染病 ； 傳染病通報 ； 通報經驗

並列摘要

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.

並列關鍵字

Notifiable Infectious Diseases ； Reporting Notifiable Diseases ； Reporting Experiences

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