Practice of defensive medicine among surgeons in Ethiopia: cross-sectional study.

BACKGROUND: Defensive medicine is physicians' deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of defensive medicine among highly litigious disciplines (surgery) and described factors associated with its practice. METHODS: Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. RESULTS: A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. CONCLUSION: The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice.

Assessment of attitude towards COVID-19 vaccine and associated factors among clinical practitioners in Ethiopia: A cross-sectional study.

BACKGROUND: Clinical practitioners are influential figures in the public's health-seeking behavior. Therefore, understanding their attitudes toward the COVID-19 vaccine is critical for implementing successful vaccination programs. Our study aimed to investigate clinical practitioners' acceptance of the COVID-19 vaccine and associated factors for evidence-based interventions. METHODS: Data from 461 clinical practitioners were collected using a cross-sectional design via an online self-administered survey. Descriptive and multiple logistic regression analyses and chi-square tests were conducted using R version 3.6.1. RESULTS: The COVID-19 vaccine was accepted by 84.4 percent of those polled, and 86.1 percent said they would recommend it to others. Individuals with advanced levels of education demonstrated greater readiness for vaccine acceptance (P<0.001) and willingness to recommend (P<0.001). On the other hand, practitioners with concerns about the safety of vaccines developed in emergency settings were less likely to accept vaccines (OR = 0.22). Practitioners influenced by social media posts (OR = 0.91) and religious beliefs (OR = 0.71) were found to be less willing to recommend the vaccine. CONCLUSION: The study demonstrated that interventions to improve clinical practitioners' acceptance and recommendation of the COVID-19 vaccine should consider the following factors: level of experience and education, religious beliefs, safety concerns, specific profession, and source of information. Vaccine literacy efforts that directly address specific concerns and misconceptions, such as those that reconcile social media information and religious beliefs with scientific literature, are recommended.