title: A cross-sectional, population-based study of HIV physicians and outpatient health care use by people with HIV in Ontario.
abstract: BACKGROUND
  People with HIV are living longer and their care has shifted towards the prevention and management of comorbidities. However, little is known about who is providing their care. Our objective was to characterize the provision of HIV care in Ontario by physician specialty.
  
  
  METHODS
  We conducted a retrospective population-based observational study using linked administrative databases in Ontario, Canada, a single payer health care system. All Ontarians with HIV were identified using a validated case ascertainment algorithm. We examined office-based health care visits for this cohort between April 1, 2009 and March 31, 2012. Physician characteristics were compared between specialty groups. We stratified the frequency and distribution of physician care into three categories: (a) care by physician specialty (family physicians, internal medicine specialists, infectious disease specialists, and other specialists), (b) care based on physician caseload (low, medium or high categorized as ≤5, 6-49 or ≥50 HIV patients per physician), and (c) care that is related to HIV versus unrelated to HIV.
  
  
  RESULTS
  Family physicians were older, graduated earlier, were more often female, and were the only group practicing in rural settings. Unlike other specialists, most family physicians (76.8%) had low-volume caseloads. There were 406,411 outpatient visits made by individuals with HIV; one-third were for HIV care. Family physicians provided the majority of care (53.6% of all visits and 53.9% of HIV visits). Internal medicine specialists provided 4.9% of all visits and 9.6% of HIV visits. Infectious disease specialists provided 12.5% of all visits and 32.7% of HIV visits. Other specialties provided 29.0% of visits; most of these (33.0%) were to psychiatrists.
  
  
  CONCLUSIONS
  The distribution of visits to physicians caring for HIV patients reveals different patterns of health care delivery by specialty and HIV caseload. Further research should delineate how specialties share care for this population and how different patterns relate to quality of care.
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, RM 337Y, Ottawa, Ontario, K1N 5C8, Canada. ckendall@uottawa.ca.|Department of Family Medicine, University of Ottawa, 43 Bruyère St., Floor 3JB, Ottawa, Ontario, K1N 5C8, Canada. ckendall@uottawa.ca.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Kendall
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill, 1020 Pine Ave. West, Montreal, Quebec, Canada. Jenna.wong@gmail.com.
authors.forename: Jenna
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Rd., Room 3105, Ottawa, Ontario, K1H 8M5, Canada. mtaljaard@ohri.ca.|Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada. mtaljaard@ohri.ca.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Room G1-06, Toronto, Ontario, M4N 3M5, Canada. rick.glazier@ices.on.ca.|Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada. rick.glazier@ices.on.ca.|Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada. rick.glazier@ices.on.ca.|Department of Family and Community Medicine, University of Toronto, 500 University Ave., 5th Floor, Toronto, Ontario, M5G 1V7, Canada. rick.glazier@ices.on.ca.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, RM 337Y, Ottawa, Ontario, K1N 5C8, Canada. whogg@uottawa.ca.|Department of Family Medicine, University of Ottawa, 43 Bruyère St., Floor 3JB, Ottawa, Ontario, K1N 5C8, Canada. whogg@uottawa.ca.
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.affiliation: Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada. jyounger@ohri.ca.
authors.forename: Jaime
authors.initials: J
authors.lastname: Younger
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, RM 337Y, Ottawa, Ontario, K1N 5C8, Canada. Dmanuel@ohri.ca.|Department of Family Medicine, University of Ottawa, 43 Bruyère St., Floor 3JB, Ottawa, Ontario, K1N 5C8, Canada. Dmanuel@ohri.ca.|Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa, Ontario, Canada. Dmanuel@ohri.ca.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D055552:Infectious Disease Medicine / Q000706:statistics & numerical data*; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D009864:Ontario; D012189:Retrospective Studies