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Attitudes towards the Eradication of Measles and CAM Orientation of General Physicians. Is There a Direct Link? A Decision Tree Analysis

Background: The goal of measles eradication is still broadly discussed by health care authorities. Several studies suggest negative attitudes of general physicians (GPs) oriented in complementary and alternative medicine (CAM) with regard to measles eradication. We intended to identify prognostic factors for positive/negative attitudes in a survey of German GPs. Methods: In 2004, a total of 732 GPs received a questionnaire to evaluate their attitudes towards the eradication of measles asking for age, gender, medical qualification, license by health insurance, CAM orientation, monthly number of early detection checkups, patients per day, appraisal of significance of legal aspects and parents' autonomy. We carried out a QUEST decision tree analysis to identify predictors for a positive/negative attitude towards the eradication of measles. Results: 621 GPs (348 conventional vs. 273 CAM-oriented GPs) sufficiently completed the questionnaire and were included in this analysis. 256 physicians (41%) had a negative attitude towards the eradication of measles. In a 3-level decision tree we found a high number of early detection checkups (U9) in children being the first predictor for a positive attitude, followed in the second node by the CAM orientation. Based on this decision tree only 27 attitudes of GPs (4.4%) were falsely classified as yielding to a kappa index of agreement of k = 0.91 (95% CI: 0.88-0.94). Discussion: The CAM orientation of the physicians is not the only predictor for positive or negative attitudes towards measles eradication. In particular, the number of early detection checkups of children seems to play a major role in this context. Future research should focus on this aspect.