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Several factors prompt patients with HIV to voluntarily switch physicians

A new national study reveals that HIV patients tend to switch doctors when they don't sufficiently trust their current doctor or don't believe the doctors are specialized or experienced enough to adequately manage HIV. Hector P. Rodriguez, Ph.D., M.P.H., of Harvard University, and colleagues analyzed results from a three-wave survey (from 1996 to 1998) of the HIV Cost and Services Utilization Study, a longitudinal study of a nationally representative sample of noninstitutionalized HIV-infected individuals receiving care in the United States. They surveyed physicians providing care and care site directors and analyzed the relationship of interpersonal aspects of care, care access and continuity, physician and site characteristics, and other factors to voluntary physician switching.

About 15 percent of patients voluntarily changed their usual clinicians during the 2-year study period. After accounting for multiple factors, patients who trusted their doctors were 26 percent less likely and those who believed their doctor was knowledgeable about antiretroviral medications were 74 percent less likely to switch doctors. Also, patients being cared for at a care site with moderate rather than low or high HIV patient volume were 92 percent less likely and those receiving care at sites with Ryan White Care Act funding were 73 percent less likely to switch doctors.

Physician sociodemographics did not play a significant role in switching. However, physician and site HIV specialization did matter. For example, patients seen by nonexpert generalists or by physicians caring for fewer than 20 HIV patients were 4.35 and 3.71 times more likely, respectively, to voluntarily switch doctors. Also, patients seen at more specialized sites were generally less likely to voluntarily switch.

The results suggest that, for HIV-infected patients, gaining access to physician expertise may be more important than maintaining visit continuity with an individual physician.

The study was supported by the Agency for Healthcare Research and Quality (HS10227 and T32 HS00055).

More details are in "Voluntary physician switching by human immunodeficiency virus-infected individuals," by Dr. Rodriguez, Ira B. Wilson, M.D., M.Sc., Bruce E. Landon, M.D., M.B.A., and others, in the March 2007 Medical Care 45(3), pp. 189-198.

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