非职业性暴露后HIV预防：急诊医生的当前实践、态度和信念。

McCausland Julie B, Linden Judith A, Degutis Linda C, Ramanujam Prasanthi, Sullivan Lisa M, D'onofrio Gail

Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.

Ann Emerg Med. 2003 Nov;42(5):651-6. doi: 10.1016/S019606440300338X.

STUDY OBJECTIVE

We surveyed emergency physicians to determine current practices, knowledge, attitudes, and beliefs regarding nonoccupational postexposure prevention practices.

METHODS

Two thousand randomly selected practicing emergency physicians from the American College of Emergency Physicians' national database and all graduating emergency medicine residents in 2000 were surveyed. Knowledge, role responsibility, self-efficacy, and attitudes and beliefs were measured and composite scores developed. Differences in responses between supporters and nonsupporters were compared for each category.

RESULTS

Eight hundred eighty-nine responded, representing 60% (67/113) of emergency medicine residencies, 32% (347/1095) of emergency medicine residents, and 27% (542/2000) of emergency physicians. Responders recommend nonoccupational postexposure prevention for sexual assault (35%), unintentional needle stick (25%), and, rarely (<15%), for unsafe sexual practices and injection drug use. Knowledge of Centers for Disease Control and Prevention recommendations or the time when treatment may be most beneficial is poor (15.5% and 13.7%, respectively). Most agree their role includes providing nonoccupational postexposure prevention drugs and referring patients for counseling (76.5% and 75.6%, respectively). Confidence in assessing need for nonoccupational postexposure prevention varied with exposure type (sexual assault [61.6%], unintentional needle stick [54.8%], unsafe sexual practices [40.4%], and injection drug use [49.7%]). Supporters of nonoccupational postexposure prevention (64.1%) are more likely to have nonoccupational postexposure prevention available (69.3% versus 42.9%; 95% confidence interval [CI] 19.7 to 33.1), written protocols (42.5% versus 33.0%; 95% CI 2.8 to 16.2), and higher mean composite scores than nonsupporters in all categories: knowledge, self-efficacy, role responsibility, and attitudes.

CONCLUSION

Most emergency physicians surveyed agree that offering nonoccupational postexposure prevention is feasible and within their role responsibility. Establishing nonoccupational postexposure prevention protocols and providing educational programs are important first steps in changing practice.

研究目的

我们对急诊医生进行了调查，以确定他们目前关于非职业性暴露后预防措施的做法、知识、态度和信念。

方法

从美国急诊医师学会的全国数据库中随机抽取2000名执业急诊医生，并对2000年所有即将毕业的急诊医学住院医师进行了调查。测量了知识、角色责任、自我效能以及态度和信念，并得出综合分数。比较了支持者和非支持者在每个类别中的回答差异。

结果

889人做出了回应，占急诊医学住院医师项目的60%（67/113）、急诊医学住院医师的32%（347/1095）以及急诊医生的27%（542/2000）。受访者推荐对性侵犯（35%）、意外针刺（25%）以及很少见的情况（<15%），如不安全的性行为和注射吸毒进行非职业性暴露后预防。对疾病控制与预防中心的建议或治疗最有益的时间的了解较差（分别为15.5%和13.7%）。大多数人同意他们的职责包括提供非职业性暴露后预防药物并为患者提供咨询转诊（分别为76.5%和75.6%）。对评估非职业性暴露后预防需求的信心因暴露类型而异（性侵犯[61.6%]、意外针刺[54.8%]、不安全的性行为[40.4%]和注射吸毒[49.7%]）。非职业性暴露后预防的支持者（64.1%）更有可能提供非职业性暴露后预防措施（69.3%对42.9%；95%置信区间[CI]19.7至33.1）、制定书面方案（42.5%对33.0%；95%CI2.8至16.2），并且在所有类别中，包括知识、自我效能、角色责任和态度方面，其平均综合分数均高于非支持者。