title: Effect of physician specialty on counseling practices and medical referral patterns among physicians caring for disadvantaged human immunodeficiency virus-infected populations.
abstract: Data regarding the care and management of human immunodeficiency virus (HIV)-infected patients provided by infectious diseases (ID)-trained physicians, compared with data for care and management provided by other specialists, are limited. Here, we report results of a self-administered survey sent to 317 physicians (response rate, 76%) in 4 metropolitan areas of the United States who were identified as providing care to disadvantaged HIV-infected patients. ID-trained physicians who responded that they strongly agreed or somewhat agreed that they had enough time to care for their HIV-infected patients were more likely than were non-ID-trained physicians to provide therapy-adherence counseling. Physicians with >or=50 patients in care and ID-trained physicians were less likely to always discuss condom use and risk reduction for HIV transmission. Factors significantly associated with referring rather than treating HIV-infected patients with hypertension or diabetes included having <50 patients in care, being an ID-trained physician, and practicing in a private practice. These results suggest the need for targeted physician training on the importance of HIV transmission prevention counseling, increasing the duration of patient visits, and improving strategies for generalist-specialist comanagement of HIV-infected patients.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Duffus
authors.forename: M
authors.initials: M
authors.lastname: Barragan
authors.forename: L
authors.initials: L
authors.lastname: Metsch
authors.forename: C S
authors.initials: CS
authors.lastname: Krawczyk
authors.forename: A M
authors.initials: AM
authors.lastname: Loughlin
authors.forename: L I
authors.initials: LI
authors.lastname: Gardner
authors.forename: P
authors.initials: P
authors.lastname: Anderson-Mahoney
authors.forename: G
authors.initials: G
authors.lastname: Dickinson
authors.forename: C
authors.initials: C
authors.lastname: del Rio
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D003376:Counseling; D004645:Empathy; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D008511:Medicine; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013038:Specialization