Reporting of gonorrhea by private physicians: a behavioral study.

Abstract

Physicians in the Denver Metropolitan Area were randomly assigned to study groups and exposed to an intervention designed to test current hypotheses concerning the reasons for underreporting of gonorrhea (lack of saliency in the request, patient interference, violation of the physician-patient relationship, insufficient rewards and excessive administrative cost to the reporter). A periodic telephone contact, initiated by the Health Department and requiring only contact between clerical personnel, more than doubled the number of reported cases. striking for those who had not previously reported, and for doctors who practiced alone. An estimate of 42 per cent was obtained for the proportion of cases reported, substantially higher than that produced by retrospective surveys based on recall. The impact of undernotification on total morbidity vill vary with the preexisting mix of public and private reporting. The telephone reporting system appears to be an inexpensive and effective program tool for determining that impact locally. (Am J Public Health 1980; 70:983-986.) porting of gonorrhea by private physicians who currently account for about 12 per cent of reported cases in the area. Our specific aims were to: determine what, if anything, may constitute adequate motivation for reporting; develop an efficient, inexpensive system for monitoring disease in the private sector; and estimate the effect of underreporting on total morbidity. Materials and MethodsThe initial sampling frame consisted of over 3,000 physicians licensed in the Denver metropolitan area in 1975. Exclusions were made on the basis of specialties unlikely to treat sexually transmitted diseases-such as psychiatry, anesthesiology, and opthamology and/or practice in a public setting or large group practices (whose internal system for disease reporting bypassed the individual physician). 18 Each of the five study groups was assigned a specific behavioral intervention aimed at testing one of the five hypotheses for underreporting. In the categorization of groups which follows, reference is made to studies suggesting that a

Syphilis and gonorrhea in Miami: similar clustering, different trends.

“…For example, private physicians may be less likely to report gonorrhea than syphilis because of the perception that gonorrhea is a less serious disease. 16 We conclude that direction of syphilis and gonorrhea trends did actually differ within the subpopulations examined. The epidemiological patterns of the diseases are not well understood, and their different trends remain particularly puzzling.…”

Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis

“…The match rate was slightly higher for African-Americans than for whites but because the rate of gonorrhea is about 30-fold higher for African Americans than for whites (Moran et al, 1989) this geocoding disparity was unlikely to bias our findings. Although census data may not be accurate in areas where there is much illegal immigration gonorrhea cases are also typically underreported, so if anything our estimates of gonorrhea rates are probably conservative (Kirsch, Shesser, & Barron, 1998;Rothenberg, Bross, & Vernon, 1980). There is no evidence of any change in the reporting processes over this time period.…”

“…An important concern is that the census tends to undercount populations in low-income areas with high rates of minorities (Anderson & Fienberg, 2000). However, the tendency to underreport gonorrhea and our geocode rate of 83% together are both likely to be even lower than a population undercount, making our annual estimates of gonorrhea rates conservative (Kirsch et al, 1998;Rothenberg et al, 1980). These biases in reporting and identifying gonorrhea cases are likely to be constant over time.…”

Underreporting and underestimation of gonorrhea cases in the Taiwan National Gonorrhea Notifiable Disease System in the Tainan region: evaluation by a pilot physician-based sentinel surveillance on Neisseria gonorrhoeae infection

“…Others have suggested reasons for the underreporting of gonorrhea, including the provider's view of a lack of benefit for both the provider and the patient on casereporting on STD control, resistance from patients, perceived violation of the doctor-patient confidential relationship, expectation of rewards on reporting, and the perceived cumbersome time-consuming bureaucratic administrative procedures. 14 In our study, only those reasons for underreporting from the provider's point of view that were based on personal practice experience over a number of cases were examined. Reasons for underreporting from the patient's point of view, which were not investigated in this study, are also valuable since they are more individualized and personal, especially with regard to confidentiality, stigmatization, and sample collection methods.…”