Preventive care among HIV-positive patients in a general medicine practice.
We randomly selected a cohort of human immunodeficiency virus (HIV)-positive patients from a large university-based general medicine practice to determine how often recommended disease prevention services are received. We used a standardized medical record review protocol to gather data from the records of 159 randomly selected HIV-positive adults followed in a university general medicine practice. We set 80% as the minimum acceptable rate of receipt of each recommended preventive service. Within three months of initiating HIV care, 88% of patients had CD4+ cell counts. Within six months, 75% had serology for syphilis, 64% had purified protein derivative tuberculin skin tests, 64% had hepatitis B serology, and 49% had pneumococcal vaccinations. Within one year, 33% had influenza vaccinations. Of 50 subjects eligible for Pneumocystis carinii prophylaxis (CD4+ cells < 200/mm3), 88% had started prophylaxis within six months. Of 56 subjects eligible for antiretroviral therapy (CD4+ cells < 500/mm3), 77% had started an antiretroviral within six months. Within one year, 22% of 23 subjects with documented nonimmunity to hepatitis B began hepatitis vaccination; only one subject completed the series of three vaccinations. Many HIV-positive patients did not receive appropriate screening tests for tuberculosis and syphilis or vaccinations for pneumococcal pneumonia, influenza, and hepatitis B. Patients did receive CD4+ cell counts, Pneumocystis carinii prophylaxis, and antiretroviral therapy at acceptable rates.
Gifford
A L
AL
Robert Wood Johnson Clinical Scholar Program, Stanford University School of Medicine, Palo Alto, California 94304.
McPhee
S J
SJ
Fordham
D
D
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy; D006716:Homosexuality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services; D012307:Risk Factors
D000998:Antiviral Agents