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 m easure compliance of general practitioners (GPs) in sentinel public he alth surveillance. More specifically, its purpose was to determine the characteristics in the SGP's profile which can be objectively associa ted with perseverance. Methods. Since 1984, the French sentinel networ k 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 surveilla nce protocol. This left-censored variable was computed from individual SGP's connection time series. Kaplan-Meier method was used to estimat e the compliances survival distribution for all the SGPs (1824 SG Ps w ho have been part of the network, at one point or another, since 1984) . Using Cox regression model, a prospective survey on the 376 most rec ent recruits allowed us to select the characteristics associated with a longer compliance. Sensitivity analyses were carried out using the b ootstrap method. Results. According to the maximum number of silences allowed by the given theoretical protocol, median compliances varied b etween 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 e pidemiology and SGPs with less than or equal to 5 or greater than or e qual to 20 years seniority. On the other hand, interest in local epide miological surveys and previous experience with other surveillance net works were associated with short compliances. We found no statistical association between compliance and computing experience, having a medi cal secretary, a particular feeling of being a 'public health actor', or the desire to belong to a GPs' network. Conclusion. We have shown o ur longitudinal method to be an efficient tool for monitoring non-comp liant SGPs with respect to given surveillance protocols. Furthermore, this approach allows us to select out of the SGPs' profile the charact eristics which are associated with a longer compliance. This regressio n model could be further refined by extending the SGPs' profile. The a dditional variables to be taken into account in this profile could be identified through a complementary sociological approach. Our work add resses the question of understanding what determines the motivation of GPs to participate in public health surveillance. This question is es sential if we hope to turn general practice information systems into g enuine public health surveillance tools.