Boscarino J A, Steiber S R
Department of Epidemiology and Biostatistics, University of California at San Francisco 94105, USA.
Public Health Rep. 1995 Jul-Aug;110(4):467-75.
Today, hospitals are involved extensively in social marketing and promotional activities. Recently, investigators from the Centers for Disease Control and Prevention (CDC) estimated that routine testing of hospital patients for human immunodeficiency virus (HIV) could identify more than 100,000 patients with previously unrecognized HIV infections. Several issues are assessed in this paper. These include hospital support for voluntary HIV testing and AIDS education and the impact that treating AIDS patients has on the hospital's image. Also tested is the hypothesis that certain hospitals, such as for-profit institutions and those outside the AIDS epicenters, would be less supportive of hospital-based AIDS intervention strategies. To assess these issues, a national random sample of 193 executives in charge of hospital marketing and public relations were surveyed between December 1992 and January 1993. The survey was part of an ongoing annual survey of hospitals and included questions about AIDS, health education, marketing, patient satisfaction, and hospital planning. Altogether, 12.4 percent of executives indicated their hospital had a reputation for treating AIDS patients. Among hospitals without an AIDS reputation, 34.1 percent believed developing one would be harmful to the hospital's image, in contrast to none in hospitals that had such a reputation (chi 2 = 11.676, df = 1, P = .0006). Although 16.6 percent did not know if large-scale HIV testing should be implemented, a near majority (47.7 percent) expressed some support. In addition, 15 percent reported that HIV-positive physicians on the hospital's medical staff should not be allowed to practice medicine, but 32.1 percent indicated that they should. Also, 33.1 percent thought the hospital should be more involved in AIDS education. Finally, certain hospital characteristics,such as location and for-profit status, were not associated with support for hospital-based AIDS interventions. Contrary to what was hypothesized,however, hospitals in AIDS epicenters were less supportive of the CDC recommendations for some reason (X2 = 7.735, df = 1, P = .005).Support for AIDS education and voluntary testing is significant among hospital marketing and public relations executives. Over the past decade, community marketing and public relations have become an integral part of the hospital's business activities.However, financial pressures now are forcing hospitals to restrict these efforts. Findings reported in this paper suggest that future health care reform may assist public health aims by redirecting these endeavors towards the fight against AIDS and other preventable diseases, not eliminating them. Additional research is needed to determine why executives in AIDS epicenters are less supportive of large-scale hospital HIV testing and counseling in comparison with those outside these areas.
如今，医院广泛参与社会营销和推广活动。最近，疾病控制与预防中心（CDC）的调查人员估计，对医院患者进行人类免疫缺陷病毒（HIV）常规检测，可识别出超过10万名此前未被诊断出感染HIV的患者。本文评估了几个问题。这些问题包括医院对自愿HIV检测和艾滋病教育的支持情况，以及治疗艾滋病患者对医院形象的影响。此外，还对一种假设进行了验证，即某些医院，如有营利性机构和位于艾滋病高发区以外的医院，对基于医院的艾滋病干预策略的支持力度较小。为评估这些问题，在1992年12月至1993年1月期间，对193名负责医院营销和公共关系的高管进行了全国随机抽样调查。该调查是对医院进行的年度持续调查的一部分，包括有关艾滋病、健康教育、营销、患者满意度和医院规划等问题。总体而言，12.4%的高管表示他们所在的医院在治疗艾滋病患者方面享有声誉。在没有艾滋病声誉的医院中，34.1%的人认为树立这样的声誉会对医院形象有害，而在有此声誉的医院中则无人持此观点（卡方检验=11.676，自由度=1，P=0.0006）。虽然16.6%的人不知道是否应实施大规模HIV检测，但近半数（47.7%）表示有些支持。此外，15%的人报告称，医院医务人员中HIV呈阳性的医生不应被允许行医，但32.1%的人表示他们应该可以行医。还有，33.1%的人认为医院应更多地参与艾滋病教育。最后，某些医院特征，如地理位置和营利状况，与对基于医院的艾滋病干预措施的支持无关。然而，与假设相反的是，出于某种原因，艾滋病高发区的医院对CDC的建议支持力度较小（卡方检验=7.735，自由度=1，P=0.005）。医院营销和公共关系高管对艾滋病教育和自愿检测的支持力度很大。在过去十年中，社区营销和公共关系已成为医院业务活动不可或缺的一部分。然而，财务压力现在正迫使医院限制这些活动。本文报告的研究结果表明，未来的医疗改革可能通过将这些活动重新导向抗击艾滋病和其他可预防疾病的斗争，而不是消除它们，来协助实现公共卫生目标。需要进行更多研究，以确定与这些地区以外的高管相比，艾滋病高发区的高管为何对大规模医院HIV检测和咨询的支持力度较小。
