title: A shift in referral patterns for HIV/AIDS patients.
abstract: OBJECTIVE
  With the rapid development (and complex prescribing patterns) of drugs for HIV/AIDS care, it is challenging for physicians to keep current. We conducted a follow-up study to a 1994 cohort study to see how care and referral patterns have changed over the last decade. In this study, we examined how family physicians in Massachusetts were caring for their HIV-infected patients, and to see whether FPs were referring more patients to specialists for care compared with a decade ago.
  
  
  METHODS
  We designed a cross-sectional survey as an 11-year follow-up to a previous study. It was mailed in 2005 to the active membership of the Massachusetts Academy of Family Physicians.
  
  
  RESULTS
  Compared with the cohort of 1994, the number of HIV+ patients in individual practices remained about the same, but the number of practices with no AIDS patients was significantly higher. 85.3% of FPs noted that they were more likely to refer HIV/AIDS patients immediately compared with their own practice patterns a decade ago. In this study, 39.0% of current respondents referred HIV+ patients immediately, 57.0% co-managed patients, and 4.1% managed these patients alone (the data for the 1994 cohort was 7.0%, 45.8%, and 47.2%, respectively; P<.0001). Similar changes were seen in regard to care patterns for AIDS patients. Among the current cohort, 61.7% reported that they referred patients immediately, compared with only 18.3% in 1994; 36.8% noted that they co-managed these patients (vs 74.3% in 1994); and only 1.5% reported that they managed these patients alone (vs 7.4% in 1994; P<.0001).
  
  
  CONCLUSIONS
  A significant shift amongst FPs with regard to their referral patterns for patients with HIV/AIDS has occurred over the last decade. The community health center has emerged as a resource for patients with HIV/AIDS. Funding for specific training programs on HIV/AIDS care should be targeted to community health centers.
authors.affiliation: University of Massachusetts Medical School, Worcester, MA 01655, USA. FournieP@ummhc.org
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Fournier
authors.forename: Judith A
authors.initials: JA
authors.lastname: Savageau
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baldor
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003153:Community Health Services / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011336:Probability; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome