PARTICIPATION OF FRENCH GENERAL-PRACTITIONERS IN PUBLIC-HEALTH SURVEILLANCE - A MULTIDISCIPLINARY APPROACH

Study objectives-To evaluate the feasibility of a novel approach to me asure compliance of sentinel general practitioners (SGPs) in sentinel public health surveillance and to determine the characteristics in the SGP's profile that can be objectively associated with their persevera nce in public health surveillance. Design-Prospective study of the com pliance of the SGPs (compliance being defined as the length of time du ring which an SGP complies with a given theoretical surveillance proto col) and qualitative study of the determinants of their initial motiva tions (using group and face to face interviews). Setting-The 1970 SGPs who have participated in the Sentinel system since 1984.Participants- Among them, the 502 SGPs recruited since 1 July 1992 have been questio ned by mailed questionnaire and 20 SGPs have been questioned during fa ce to face semistructured interviews. Main results-According to the ma ximum number of silences allowed by the given theoretical protocol, me dian compliances varied between 1.9 months (95% CI=(1.8, 2.0)) and 14. 3 months (95%CI=(13.8, 15.2)). In multivariate analysis, long complian ces for SGPs with a less than or equal to 5 or greater than or equal t o 20 years seniority was seen and an interest in using multimedia home servers. On the other hand, interest in local epidemiological surveys and previous experience with other surveillance networks or clinical trials were associated with short compliances. No statistical associat ion was found between compliance and computing experience, having a me dical secretary, a particular feeling of being a ''public health actor '', or the desire to belong to a GPs' network. A thematic analysis of interview records showed that the main motivation of the SGPs was thei r need to share their experiences and to self evaluate by comparison w ith colleagues by the means of a surveillance system that would be use d as a health information system. Conclusions-The longitudinal method used in this study was shown to be an efficient tool to monitor non-co mpliant SGPs with respect to given surveillance protocols. Furthermore , this approach allows the selection out of the SGPs' profile the char acteristics that are associated with a longer compliance. The addition al variables to be taken into account in this profile could be identif ied among the topics, attitudes, and experiences collected during the semistructured interviews. This work considers the question of underst anding what determines the motivation of GPs to participate in public health surveillance and what are their expectations of feed back. This question is essential if information systems in general practice are to be implemented.