Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users
Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users
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DOI：
10.1001/archinte.165.6.618
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发表时间：
2005-03-28
影响因子：
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通讯作者：
Cleary, PD
中科院分区：
文献类型：
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作者：
Ding, L;Landon, BE;Cleary, PD
背景：我们评估了医生的培训、经验和执业特点，并考察了他们对注射吸毒者(IDU)中人类免疫缺陷病毒(HIV)感染者的态度与护理质量的关系。方法：对美国非制度化HIV感染者及其主要HIV护理医生进行横断面调查。评估医生和执业人员的特征、培训、HIV知识、经验、对HIV感染者的态度、压力水平和执业满意度。主要的护理质量指标是患者接受高效抗逆转录病毒治疗、报告的问题、对护理的满意度、未得到满足的需求和对护理的获得性。结果：在全国范围内，23.2%的HIV感染患者的医生对注射毒品持负面态度。看更多的注射吸毒者、有更高的HIV治疗知识得分和每周治疗的患者较少独立地与对注射吸毒者更积极的态度相关。到1996年12月，由消极态度的医生照顾的注射吸毒者接受高效抗逆转录病毒治疗的调整比率(13.5%)显著低于由消极态度的医生照顾的非注射吸毒者(36.1%)或由积极态度的医生照顾的注射吸毒者(32.3%)。医生的态度与其他护理问题、护理满意度、未满足的需求或感知的护理途径无关。结论：消极的态度可能导致对注射吸毒者和其他边缘人群的护理不够理想。提供教育或基于经验的练习，或确保临床医生有足够的时间处理复杂的问题，可能会带来更好的态度和更高的护理质量。
Background: We evaluated physicians' training, experience, and practice characteristics and examined associations between their attitudes toward human immunodeficiency virus (HIV)-infected persons who are injection drug users (IDUs) and quality of care.Methods: Cross-sectional surveys were conducted among a probability sample of noninstitutionalized HIV-infected individuals in the United States and their main HIV care physicians. Physician and practice characteristics, training, HIV knowledge, experience, attitudes toward HIV-infected IDUs, stress levels, and satisfaction with practice were assessed. The main quality-of-care measures were patient exposure to highly active antiretroviral therapy, reported problems, satisfaction with care, unmet needs, and perceived access to care.Results: Nationally, 23.2% of HIV-infected patients had physicians with negative attitudes toward IDUs. Seeing more IDUs, having higher HIV treatment knowledge scores; and treating fewer patients per week were independently associated with more positive attitudes toward IDUs. Injection drug users who were cared for by physicians with negative attitudes had a significantly lower adjusted rate of exposure to highly active antiretroviral therapy by December 1996 (13.5%) than non-IDUs who were cared for by such physicians (36.1%) or IDUs who were cared for by physicians with positive attitudes (32.3%). Physician attitudes were not associated with other problems with care, satisfaction with care, unmet needs, or perceived access to care.Conclusions: Negative attitudes may lead to less than optimal care for IDUs and other marginalized populations. Providing education or experience-based exercises or ensuring that clinicians have adequate time to deal with complex problems might result in better attitudes and higher quality of care.