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Quality of hospital HIV care is similar regardless of physician HIV experience or hospitalist status
With the advent of highly active antiretroviral therapy (HAART), fewer patients with HIV disease are hospitalized. When patients are hospitalized, however, it tends to be for problems such as HIV-related liver disease (such as hepatitis C) and medication toxicity rather than opportunistic infections due to dramatically weakened immune systems common in the pre-HAART era.
Outpatients with HIV generally fare better and are less likely to be hospitalized if treated by physicians with more experience treating the disease. Yet, a physician's HIV-related experience and treatment by a hospitalist (generalist physician specialized in caring for hospitalized patients) or nonhospitalist does not seem to affect the care or outcomes of hospitalized patients with HIV disease, suggests a new study.
Researchers found little difference in in-hospital mortality and processes of care measures for 1,207 patients treated by hospitalists and nonhospitalists at 6 academic medical centers during a 2-year period. Physician HIV-specific inpatient experience also did not seem to affect medical resource use, patient outcomes, or processes of care. However, both hospitalists and nonhospitalists with more experience with HIV-infected inpatients tended to use fewer medical resources. Also, patients who received hospitalist care trended toward having longer hospital stays than those who received nonhospitalist care (6 vs. 5.2 days). Finally, inpatient providers with moderate experience with HIV-infected patients were twice as likely to coordinate care with outpatient providers (now the cornerstone of HIV care) than those with the least experience with HIV-infected patients, but this pattern did not extend to providers with the highest level of experience.
The findings were based on analysis of administrative data and in-hospital and 30-day follow-up interviews with patients at the six medical centers. The study was supported in part by the Agency for Healthcare Research and Quality (HS10597).
More details are in "Do hospitalists or physicians with greater inpatient HIV experience improve HIV care in the era of highly active antiretroviral therapy? Results from a multicenter trial of academic hospitalists," by John A. Schneider, M.D., M.P.H., Qi Zhang, Ph.D., Andrew Auerbach, M.D., M.P.H., and others, in the April 1, 2008, Clinical Infectious Diseases 46, pp. 1085-1092.
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