醫師對愛滋病照護經驗、知識及態度的變遷：1994及2012年調查之比較

Evolving Hiv-related Clinical Experiences, Knowledge, and Attitudes of Physicians: A Comparison of 1994 and 2012 Survey

丁志音(Lew Chih-Yin Ting) ； 李芳盈(Fang-Ying Li) ； 方啟泰(Chi-Tai Fang)

《台灣公共衛生雜誌》 32卷5期 (2013/10) Pp. 435-448

https://doi.org/10.6288/TJPH2013-32-05-03

摘要

目標：比較1994及2012年醫師的愛滋病照護經驗、知識與態度的差異。方法：分別於1994及2012年針對70歲以下之執業西醫師進行全國性郵寄問卷調查，並以加權分布、卡方、趨勢檢定、羅吉斯迴歸、Gamma（95％ CL）、及標準化進行年代間比較。結果：1994及2012年有效樣本各為1,702及1,590人。整體而言，曾直接照顧過HIV感染者的醫師比例大幅上升（從13.1％至45.5％），愛滋專業知識水準亦顯著提升，而臨床場域中的愛滋照護氛圍也有顯著改善，此反映在願意照護所有感染者的比例大幅提升（從26.7％至43.2％），且恐懼與憂慮顯著下降。但本研究亦發現兩個值得關注的現象，（1）感染HIV的注射藥癮者持續為醫師最不願意照顧的族群；（2）持續有極高比例的外科系醫師憂懼遭病人傳染HIV（從85.7％至84.6％）。結論：隨時間演進，整體而言，醫師對感染者的照護經驗、知識及態度皆有大幅度正向改善。然而藥癮HIV感染者的醫療照護問題及外科系醫師的職業風險仍需持續關注。在醫學繼續教育中安排藥癮者醫療照護專業課程，以及在制度面上確保外科醫師執業受傷後皆能盡快接受抗HIV病毒藥物預防性投藥是可思考的方向。

關鍵字

照護意願 ； 風險知覺 ； 愛滋臨床知識 ； 專業倫理

並列摘要

Objectives: This study compared physicians' HIV clinical experiences, and their knowledge and attitudes toward HIV care in 1994 and 2012. Methods: National mailing surveys among practicing physicians 70 years old and younger were conducted in 1994 and 2012. Weighted distribution, Chi-Square, trend test, logistic regression, Gamma (95% CL), and standardization were employed to make between-year analyses. Results: There were 1,702 and 1,590 doctors participated in 1994 and 2012 study, respectively. The percentage of physicians who had ever provided care for HIV-positive patients increased considerably (from 13.1% to 45.5%) along with a moderately improved average knowledge on HIV diseases. The climate of HIV care delivery has been markedly improved over this time period, which can be reflected in the significantly increased willingness to treat all HIV patients (from 26.7% to 43.2%) and a substantial decline in fear and anxiety. Nonetheless, we did identify two points of concern: (1) HIV-positive injecting drug users (IDUs) continued to be the most undesirable group for whom physicians provided care; (2) there continued to be a very high percentage of surgeons expressing fear/anxiety about the risk of being infected by HIV-positive patients. Conclusions: Even with the evolving HIV epidemic in Taiwan, there has been a remarkable overall improvement in the clinical experiences, knowledge and attitudes of physicians in treating HIV patients. However, there is still a need to strengthen continuing medical education on HIV care, particularly targeting the care of IDUs. It is also necessary to ensure that all surgeons who are exposed to HIV have access to post-exposure prophylaxis with highly active antiretroviral therapy as soon as possible.

並列關鍵字

willingness to treat ； risk perceptions ； HIV clinical knowledge ； professional ethics

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