Relation of physician specialty and HIV/AIDS experience to choice of guideline-recommended antiretroviral therapy.
BACKGROUND
Controversy exists regarding who should provide care for those with HIV/AIDS. While previous studies have found an association between physician HIV experience and patient outcomes, less is known about the relationship of physician specialty to HIV/AIDS outcomes or quality of care.


OBJECTIVE
To examine the relationship between choice of appropriate antiretroviral therapy (ART) to physician specialty and HIV/AIDS experience.


METHODS
Self-administered physician survey.


METHODS
Random sample of 2,478 internal medicine (IM) and infectious disease (ID) physicians.


METHODS
Choice of guideline-recommended ART.


RESULTS
Two patients with HIV disease, differing only by CD4+ count and HIV RNA load, were presented. Respondents were asked whether ART was indicated, and if so, what ART regimen they would choose. Respondents' ART choices were categorized as "recommended" or not by Department of Health and Human Services guidelines. Respondents' HIV/AIDS experience was categorized as moderate to high (MOD/HI) or none to low (NO/LO). For Case 1, 72.9% of responding physicians chose recommended ART. Recommended ART was more likely (P <.01) to be chosen by ID physicians (88.2%) than by IM physicians (57.1%). Physicians with MOD/HI experience were also more likely (P <.01) to choose recommended ART than those with NO/LO experience. Finally, choice of ART was examined using logistic regression: specialty and HIV experience were found to be independent predictors of choosing recommended ART (for ID physicians, odds ratio [OR], 4.66; 95% confidence interval [95% CI], 3.15 to 6.90; and for MOD/HI experience, OR, 2.05; 95% CI, 1.33 to 3.16). Results for Case 2 were similar. When the analysis was repeated excluding physicians who indicated they would refer the HIV "patient," specialty and HIV experience were not significant predictors of choosing recommended ART.


CONCLUSIONS
Guideline-recommended ART appears to be less likely to be chosen by generalists and physicians with less HIV/AIDS experience, although many of these physicians report they would refer these patients in clinical practice. These results lend support to current recommendations for routine expert consultant input in the management of those with HIV/AIDS.
Stone
V E
VE
Division of General Internal Medicine, Department of Medicine, Memorial Hospital of Rhode Island, Brown University School of Medicine, Providence, RI, USA. vstone@partners.org
Mansourati
F F
FF
Poses
R M
RM
Mayer
K H
KH
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003625:Data Collection; D004501:Education, Medical; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013038:Specialization; D014686:Venereology / Q000193:education / Q000706:statistics & numerical data