Who Provides Primary Care? An Assessment of HIV Patient and Provider Practices and Preferences.
BACKGROUND
Non-AIDS co-morbidities are emerging as the main health problems for those living with HIV, and primary care for this population is an evolving challenge. Recent studies have raised the question of whether specialists or generalists are best suited to provide HIV primary care, but patients' actual usage patterns and the preferences of patients and providers have not been well studied.


METHODS
We anonymously surveyed 98 patients and eight HIV-specialized providers regarding primary care usage patterns and preferences at an academic HIV clinic in Los Angeles that serves insured patients.


RESULTS
Fifty-nine percent of patients use their HIV physician as their primary care provider, and 84% would prefer this model. Physicians were divided on their preferred role, with five out of eight desiring to provide both primary care and HIV care. All eight physicians rated their comfort with antiretroviral therapy and opportunistic infections greater than for non-AIDS co-morbidities. Eighty-one percent of patients and seven of eight providers were supportive of having a co-located primary care physician at the HIV clinic.


CONCLUSIONS
We conclude that patients prefer integration of HIV and primary care, but providers have variable desire to serve as primary care physicians and may be uncomfortable with non-AIDS co-morbidities. This raises the need for improved patient-provider communication about primary care needs, and calls for novel ways of systematically providing primary care to HIV-infected patients.
UCLA Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, USA.
Quen J
QJ
Cheng
UCLA Division of Infectious Diseases and Center for Clinical AIDS Research and Education, Department of Medicine, David Geffen School of Medicine at UCLA, USA.
Elysia M
EM
Engelage
Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, USA.
Tristan R
TR
Grogan
UCLA Division of Infectious Diseases and Center for Clinical AIDS Research and Education, Department of Medicine, David Geffen School of Medicine at UCLA, USA.
Judith S
JS
Currier
UCLA Division of Infectious Diseases and Center for Clinical AIDS Research and Education, Department of Medicine, David Geffen School of Medicine at UCLA, USA.
Risa M
RM
Hoffman
AIDS; HIV; Primary care