title: Attitudes about providing HIV care: voices from publicly funded clinics in California.
abstract: BACKGROUND
  As the enactment of health care reform becomes a reality in the USA, it has been widely predicted that HIV+ patients will increasingly be cared for by primary care physicians (PCPs), many of whom lack the experience to deliver full-spectrum HIV care.
  
  
  OBJECTIVE
  To describe PCPs' preparedness for an influx of HIV+ patients.
  
  
  METHODS
  This qualitative study included interviews with 20 PCPs from community health centres in California. We inquired about clinicians' experiences with HIV, their strategies for dealing with unfamiliar aspects of medicine and their management of complicated patients. We also identified the clinicians' preferred types of information and consultation resources.
  
  
  RESULTS
  PCPs are not yet comfortable as providers of comprehensive HIV care; however, they are dedicated to delivering excellent care to all of their patients, regardless of disease process. Although they prefer to refer HIV+ patients to centres of excellence, they are willing to adopt full responsibility when necessary and believe they can deliver high-quality HIV care if provided with adequate consultation and informational resources.
  
  
  CONCLUSIONS
  The Affordable Care Act will insure an estimated 20000 more HIV+ patients in California. With a dwindling supply of HIV specialists, many of these patients will be principally cared for by PCPs. PCPs will go to great lengths to ensure that HIV+ patients receive superior care, but they need the support of HIV specialists to expand their skills. Priority should be given to ensuring that expert consultation is widely available to PCPs who find themselves caring for HIV+ patients.
authors.affiliation: Department of Family and Community Medicine and.
authors.forename: Revery
authors.initials: R
authors.lastname: Barnes
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.affiliation: Department of Family and Community Medicine and walduraj@fcm.ucsf.edu.
authors.forename: Jessica F
authors.initials: JF
authors.lastname: Waldura
mesh_terms: D001291:Attitude of Health Personnel; D002140:California / Q000453:epidemiology; D002983:Clinical Competence / Q000592:standards*; D003151:Community Health Centers / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D058991:Patient Protection and Affordable Care Act; D018802:Patient-Centered Care / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D058007:Physicians, Primary Care / Q000523:psychology* / Q000592:standards / Q000639:trends; D036301:Qualitative Research; D014481:United States; D000078329:Workforce
keywords: Attitude; HIV; community health centres; physicians; primary care; qualitative research.