Pinto Sharrel L, Lipowski Earlene, Segal Richard, Kimberlin Carole, Algina James
University of Toledo College of Pharmacy, Toledo, OH 43606, USA.
J Med Ethics. 2007 Jun;33(6):313-9. doi: 10.1136/jme.2005.015529.
To identify factors that predict physicians' intent to comply with the American Medical Association's (AMA's) ethical guidelines on gifts from the pharmaceutical industry.
A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms (eg, peers, patients, etc), facilitating conditions (eg, knowledge of the guidelines, etc), profession-specific precedents (eg, institution's policies, etc), individual-specific precedents (physicians' own discretion, policies, etc) and intent. Multivariate regression modelling was conducted.
Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% (n = 133) of respondents were aware of the guidelines; 50% (n = 107) had read them. 48% (n = 102) thought that following the guidelines would increase physicians' credibility and professional image; 68% (n = 145) agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education (CME) events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent (R(2) = 0.52, p <0) were attitude, subjective norms, the interaction term (attitude and subjective norms), sponsorship of CME events and individual-specific precedents.
Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance.
确定能够预测医生遵守美国医学协会（AMA）关于制药行业礼品的道德准则意愿的因素。
2004年6月设计了一项调查问卷，并邮寄给美国佛罗里达州850名医生的随机样本，不包括执照无效、地址不完整、在其他州的地址以及预测试参与者的医生。因子分析提取了六个因素：对遵循准则的态度、主观规范（如同行、患者等）、促进条件（如对准则的了解等）、特定专业先例（如机构政策等）、特定个人先例（医生自己的判断、政策等）以及意愿。进行了多变量回归建模。
收到了来自213名代表所有专业的医生的调查问卷，净回复率为25.5%。62%（n = 133）的受访者知晓这些准则；50%（n = 107）读过这些准则。48%（n = 102）认为遵循这些准则会提高医生的可信度和专业形象；68%（n = 145）同意这样做很重要。遵守意愿与态度、主观规范、促进因素以及继续医学教育（CME）活动的赞助呈正相关，而特定个人先例与遵守意愿呈负相关。意愿的预测因素（R² = 0.52，p <0）是态度、主观规范、交互项（态度和主观规范）、CME活动的赞助以及特定个人先例。
如果医生对准则持积极态度、有更强的主观规范、对CME赞助的期望较少且特定个人先例较少，那么他们更有可能遵循AMA准则。尽管认为遵守准则会带来积极结果的信念较少，但认为重要个人或组织期望他们遵守准则的医生更有可能表达遵守意愿。
