Primary care consultations and costs among HIV-positive individuals in UK primary care 1995-2005: a cohort study.
OBJECTIVE
To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence.


METHODS
Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record.


RESULTS
348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at pound100.27 for male patients and pound117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications.


CONCLUSIONS
HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways.
Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UK.
H E R
HE
Evans
A
A
Tsourapas
C H
CH
Mercer
G
G
Rait
S
S
Bryan
M
M
Hamill
V
V
Delpech
G
G
Hughes
G
G
Brook
T
T
Williams
A M
AM
Johnson
S
S
Singh
I
I
Petersen
T
T
Chadborn
J A
JA
Cassell
D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005194:Family Practice / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult