Monitoring the compliance of sentinel general practitioners in public health surveillance: which GPs persevere?

OBJECTIVES This study was undertaken to develop a novel approach to measure compliance of general practitioners (GPs) in sentinel public health surveillance. More specifically, its purpose was to determine the characteristics in the SGP's profile which can be objectively associated with perseverance. METHODS Since 1984, the French sentinel network has collected weekly data on eight communicable diseases, involving volunteer SGPs. In this study, 'compliance' was defined as the length of time during which a SGP complies with a given theoretical surveillance protocol. This left-censored variable was computed from individual SGP's connection time series. Kaplan-Meier method was used to estimate the compliances survival distribution for all the SGPs (1824 SGPs who have been part of the network, at one point, or another, since 1984). Using Cox regression model, a prospective survey on the 376 most recent recruits allowed us to select the characteristics associated with a longer compliance. Sensitivity analyses were carried out using the bootstrap method. RESULTS According to the maximum number of silences allowed by the given theoretical protocol, median compliances varied between 11.7 (95% CI: 11.1-12.3) and 38.8 (95% CI: 35.7-40.7) months. In multivariate analyses we observed long compliances for SGPs whose main motivation for being involved in the network was an interest in epidemiology and SGPs with < or = 5 or > or = 20 years seniority. On the other hand, interest in local epidemiological surveys and previous experience with other surveillance networks were associated with short compliances. We found no statistical association between compliance and computing experience, having a medical secretary, a particular feeling of being a 'public health actor', or the desire to belong to a GPs' network. CONCLUSION We have shown our longitudinal method to be an efficient tool for monitoring non-compliant SGPs with respect to given surveillance protocols. Furthermore, this approach allows us to select out of the SGPs' profile the characteristics which are associated with a longer compliance. This regression model could be further refined by extending the SGPs' profile. The additional variables to be taken into account in this profile could be identified through a complementary sociological approach. Our work addresses the question of understanding what determines the motivation of GPs to participate in public health surveillance. This question is essential if we hope to turn general practice information systems into genuine public health surveillance tools.

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