Primary care for patients infected with human immunodeficiency virus: a randomized controlled trial.
OBJECTIVE
To measure the impact of a teaching intervention and to compare process and outcomes of care for HIV-infected patients randomly assigned to a general medicine clinic (GMC) or an infectious disease clinic (IDC) for primary care.


METHODS
Prospective, randomized, controlled trial.


METHODS
University hospital in Durham, NC.


METHODS
Two hundred fourteen consecutive HIV-infected patients presenting for primary care.


METHODS
Physicians at the GMC received HIV-related training and evidence-based practice guidelines.


METHODS
Utilization of services, health-related quality of life, preventive and screening measures, and antiretroviral use for one year.


RESULTS
At baseline GMC patients were more likely to be African American (85% vs 71%; P =.03) and had lower baseline CD4+ cell counts than IDC patients (262 +/- 269 vs 329 +/- 275; P =.05). A similar and high proportion of patients in both groups received appropriate preventive care services including Pneumocystis carinii pneumonia (PCP) prophylaxis, pneumococcal vaccination, and antiretroviral therapy. Screening for TB was more frequent in GMC (89% vs 68%; P =.001). In the year following randomization, GMC patients made more visits to the emergency department than IDC patients (1.6 +/- 3.0 vs 0.7 +/- 1.5; P =.05). Hospital use was higher for GMC patients with average length of stay 7.8 +/- 6.3 days compared to 5.7 +/- 3.8 days for IDC patients (P =.01). In analyses, which adjust for potential baseline imbalances, these differences remained.


CONCLUSIONS
Targeted education in GMC achieved similar provision of primary care for GMC patients, yet use of health care services was higher for this group. The delivery of adequate primary care is necessary but not sufficient to produce changes in health care utilization.
Keitz
S A
SA
Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC 27705, USA. sheri.keitz@duke.edu
Box
T L
TL
Homan
R K
RK
Bartlett
J A
JA
Oddone
E Z
EZ
D003266:Continuity of Patient Care / Q000458:organization & administration; D005194:Family Practice / Q000193:education*; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000628:therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008511:Medicine; D009657:North Carolina; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D013038:Specialization; D014600:Utilization Review