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Primary Care Research

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Generalist physicians with appropriate experience and expertise can provide high-quality care to patients with HIV

Patients with human immunodeficiency (HIV) disease require specialized care in managing complex medication regimens and treating other medical conditions such as hepatitis C infection or high cholesterol and insulin resistance that result from highly active antiretroviral therapy (HAART). Generalist physicians with appropriate experience and expertise in HIV care can provide these patients with the same quality of care as infectious disease specialists.

Researchers, supported by the Agency for Healthcare Research and Quality (HS10408), assessed the relationship between physician specialty training and expertise and quality of care delivered to patients with HIV who received care at 64 Ryan White CARE (Comprehensive AIDS Resources Emergency) Act-funded clinics. The patients' medical records were reviewed to determine the quality of care based on measures such as use of HAART for eligible patients, screening and prophylaxis for HIV-related conditions, and measurement of CD4 cell counts and viral loads.

Of the 177 responding physicians caring for these patients, 58 percent were general medicine physicians and 42 percent were infectious disease specialists. Nearly two-thirds (63 percent) of generalists considered themselves experts in HIV care. More than 80 percent of patients with HIV being treated by infectious disease specialists and expert generalists were receiving HAART compared with 73 percent of patients of nonexpert generalists. Similarly, about 40 percent of patients who received care from infectious disease specialists or expert generalists had their viral load controlled compared with 31 percent of patients receiving care from nonexpert generalists.

See "Physician specialization and the quality of care for human immunodeficiency virus infection," by Bruce E. Landon, M.D., M.B.A., Ira B. Wilson, M.D., M.Sc., Keith McInnes, M.S., and others, in the May 23, 2005, Archives of Internal Medicine 165, pp. 1133-1139.

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