Differences between infectious diseases-certified physicians and general medicine-certified physicians in the level of comfort with providing primary care to patients.
BACKGROUND
Human immunodeficiency virus (HIV)-related mortality has decreased because of highly active antiretroviral therapy. As the life expectancy of HIV-infected patients has increased, the management of comorbid disease in such patients has become a more important concern. We examined the level of comfort self-reported by experts in HIV medicine with prescribing medications to HIV-infected patients for hyperlipidemia, diabetes, hypertension, and depression.


METHODS
As part of a larger project (the Veterans Aging Cohort Study), physicians at infectious diseases (ID) clinics and physicians at general medical (GM) clinics were asked to complete a survey requesting information about demographic characteristics, training and certification received, and self-reported comfort with prescribing medications for patients with hyperlipidemia, diabetes, hypertension, and/or depression. Comfort was rated using a 5-point Likert scale, with scores of 4-5 classified as "comfortable."


RESULTS
Of 150 attending physicians surveyed, 51 (34%) were ID certified, 33 (22%) were GM certified but practicing at an ID clinic, and 66 were GM certified and practicing at a GM clinic. Comorbid conditions were common among HIV-infected patients treated at the ID clinics (22% of these patients had hyperlipidemia, 17% had diabetes, 40% had hypertension, and 27% had depression). However, comfort with treating these conditions was less among physicians at the ID clinic. For example, comfort treating patients with hyperlipidemia was greater for GM-certified physicians at GM clinics than for GM-certified physicians and ID-certified physicians at ID clinics (98% vs. 73% and 71%, respectively; P < .0001 for trend). A similar pattern was seen for treating patients with diabetes and hypertension (P < .0001). Comfort with treating patients with depression was generally lower, particularly among physicians at ID clinics (P < .0001).


CONCLUSIONS
We found that ID-certified physicians and GM-certified physicians at ID clinics reported less comfort prescribing medications for common comorbid conditions, compared with generalist physicians at GM clinics, despite a substantial prevalence of these conditions at the ID clinics. Methods are needed to increase physicians' level of comfort for prescribing treatment and/or to facilitate referral to other physicians for treatment.
Fultz
Shawn L
SL
Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA.
Goulet
Joseph L
JL
Weissman
Sharon
S
Rimland
David
D
Leaf
David
D
Gibert
Cynthia
C
Rodriguez-Barradas
Maria C
MC
Justice
Amy C
AC
D003625:Data Collection; D004501:Education, Medical; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008511:Medicine; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D013038:Specialization; D011795:Surveys and Questionnaires