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1st
appeared 17 February 1999
Survey Shows HIV-Infected Patients Receive Differing
Qualities of Care Depending on their Provider's Experience
A survey conducted by the Community Consortium of nearly one
thousand primary care providers shows a positive relationship between the quality of care
HIV-infected patients receive and the experience of providers in treating HIV.
"Physicians with more experience were more likely to recommend treatment that
reflected the latest standards of care," said Thomas Mitchell, UCSF specialist and
program director of the Community Consortium.
Of the 999 questionnaires mailed in 1996, 524 responses were received (52 percent response
rate). Most respondents surveyed were infectious disease specialists, internists, or
family practitioners located in over twenty cities across the United States. Significant
differences were seen in the treatment chosen by providers with one to five HIV-infected
patients compared to providers with six or more patients. The results from the survey
appeared in the January 1999 issue of Clinical Infectious Diseases.
"This study was conducted just as protease inhibitors were introduced into the care
regimens of people with HIV," said senior author Donald Abrams, UCSF professor of
medicine. "The treatment situation has become even more complex now."
The self-administered questionnaire asked providers what drugs they usually prescribed for
treatment and prevention of thirty HIV-related conditions. Experienced providers, as
measured by the number of HIV-infected patients currently seen in their practice, were
more likely to use the most effective drug therapies available, including triple
combination antiretroviral therapy and multidrug combinations to fight opportunistic
infections.
Although these therapies have the potential for serious adverse effects, they can
significantly improve survival rates and lower cost of long-term care. "The decision
of when to initiate drug therapy and what combination of drugs to use is critical,"
said Mitchell, "and the consequences of making the wrong decisions are
significant."
In the early years of the AIDS epidemic, many health care analysts favored the
decentralization of HIV care among generalists, Mitchell said. But with more complex and
advanced treatments, there has been a shift toward having experienced providers care for
HIV patients. "We observed a consistent trend," noted Mitchell. "The higher
the number of HIV-infected patients that the provider was treating, the more closely his
or her reported treatment methods coincided with the latest standards of care. Now, more
than ever, it is important that patients with HIV should have access to and be cared for
by experienced physicians."
Fearing an influx of patients who may be high-volume users of health care, many managed
health care plans do not identify or advertise physicians who are expert in the management
of HIV infection, Mitchell said. Consequently, many patients may be assigned to physicians
with little experience or training in this disease.
Links:
Community Consortium
Physicians With More Experience
Are More Aggressive in Treating HIV Disease, Study Finds
Source: Corinna Kaarlela, News
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