[Assessment of the habits of physicians involved in the management of HIV-infected patients. A clinical audit on the biological follow-up].
BACKGROUND
The aim of this study was to assess the habits of hospital and community-based physicians involved in the management of HIV-infected patients and to measure the gap between their practice and follow-up guidelines.


METHODS
The guidelines considered as reference were the 1998 Dormont report. Data were prospectively collected from the medical files of the first 10 HIV-infected patients who presented for an out-patient visit (laboratory tests at initial consultation, type and frequency of follow-up during the previous year, relation between biological data and treatment strategy).


RESULTS
22 physicians (14 hospital-based physicians (HP) and 8 community-based general practitioners (GP) participated in the survey. Initial biological data were available for 211 patients; 45% had tests strictly conforming to the recommendations (HP: 57%, GP 23%; p<0.001). Among patients followed by a GP, the initial biological assessment was adequate in 7% of cases when an opiate substitute was prescribed versus 33% in the absence of opiate substitute prescription (p=0.05). For all patients, syphilis serology was the test most frequently lacking (38%). Among 78 patients with HIV-RNA levels>5,000 copies/ml, 18% did not benefit from a change in treatment. Among the patients treated by a GP, 15% had a three-fold increase in HIV-RNA, compared to their initial measurement. Of these, 3/4 were redirected to a hospital out-patient unit.


CONCLUSIONS
This study highlights the discrepancy between initial laboratory testing and expert recommendations, particularly concerning patients attended by a GP. Improvement in data collection is essential. However, recommendations concerning patients' biological follow-up are applied, with the exception of the delay between the initial prescription or treatment modification and HIV-RNA measurement, which should be shortened.
Prouvost-Keller
B
B
Réseau ville-hôpital VIH des Alpes-Maritimes. provost-keller.b@chu-nice.fr
Hofliger
P
P
Pradier
C
C
Mondain
V
V
Caselles
D
D
Dellamonica
P
P
Fuzibet
J-G
JG
Pesce
A
A
D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D019562:Viral Load