title: The effect of care team composition on the quality of HIV care.
abstract: Compared to single-clinician care, care provided by multiple clinicians might result in higher-quality care, especially if some of them have condition-specific expertise and complementary knowledge, skills, and roles. Individual physician continuity, which has been shown to be associated with care quality, necessarily decreases when care is provided by multiple clinicians. This study uses data from the HIV Cost and Services Utilization Study to assess the effect of care team composition on the quality of HIV care. In adjusted analyses, care teams composed of three or more clinicians were associated with more consistent prescribing of pneumocystis carinii pneumonia prophylaxis when medically indicated ( p < .01). Patients with multiple physicians generally reported worse care coordination, however, and had more inappropriate use of emergency services. These findings indicate both advantages and disadvantages to having multiple clinicians. More effort should be devoted to facilitating coordination when multiple clinicians provide care.
authors.affiliation: University of Washington, Seattle, USA. hrod@u.washington.edu
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Peter V
authors.initials: PV
authors.lastname: Marsden
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D011787:Quality of Health Care; D014481:United States