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Use of highly active antiretroviral therapy (HAART), which is recommended by national guidelines for the treatment of HIV infection and AIDS, has dramatically reduced the number of deaths from AIDS. However, these complex drug regimens require detailed knowledge of multiple side effects and drug interactions, as well as frequent monitoring and adjustments to achieve maximal benefit for the patient. The good news is that generalist physicians who develop expertise in HIV/AIDS care are able to provide care comparable to that of HIV/AIDS specialists, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS10227 and HS08578).
The researchers analyzed data on 1,820 patients with HIV or AIDS enrolled in the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of people receiving care for HIV, and their 374 primary care physicians (PCPs). They examined the association of PCP specialty training and experience in the care of HIV disease with the adoption and use of HAART. They also looked at rates of HAART use at 12 months and 18 months after approval of the first HAART medication in January 1996.
Among the PCPs involved, 40 percent were formally trained in infectious diseases (ID), 38 percent were general medicine physicians with self-reported expertise in the care of HIV, and 22 percent were general medicine physicians without expertise in the care of HIV. The majority of physicians (69 percent) reported a current HIV caseload of 50 patients or more. Overall, nearly 40 percent of patients were taking HAART therapy by December 1996, and nearly 66 percent were taking it by June 1997.
After controlling for patient characteristics, there were no differences between generalist experts and ID physicians in rates of HAART use in December 1996. However, patients being treated by nonexpert general medicine physicians were less likely to be on HAART, compared with patients being treated by physicians with infectious diseases training. This difference had narrowed somewhat by June 1997, suggesting that over time, the broader physician community successfully adopted HAART therapy.
See "Physician specialization and antiretroviral therapy for HIV," by Bruce E. Landon, M.D., M.B.A., Ira B. Wilson, M.D., M.Sc., Susan E. Cohn, M.D., M.P.H., and others, in the April 2003 Journal of General Internal Medicine 18, pp. 233-241.
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