title: A population-based study comparing patterns of care delivery on the quality of care for persons living with HIV in Ontario.
abstract: OBJECTIVE
  Physician specialty is often positively associated with disease-specific outcomes and negatively associated with primary care outcomes for people with chronic conditions. People with HIV have increasing comorbidity arising from antiretroviral therapy (ART) related longevity, making HIV a useful condition to examine shared care models. We used a previously described, theoretically developed shared care framework to assess the impact of care delivery on the quality of care provided.
  
  
  METHODS
  Retrospective population-based observational study from 1 April 2009 to 31 March 2012.
  
  
  METHODS
  13 480 patients with HIV and receiving publicly funded healthcare in Ontario were assigned to one of five patterns of care.
  
  
  METHODS
  Cancer screening, ART prescribing and healthcare utilisation across models using adjusted multivariable hierarchical logistic regression analyses.
  
  
  RESULTS
  Models in which patients had an assigned family physician had higher odds of cancer screening than those in exclusively specialist care (colorectal cancer screening, exclusively primary care adjusted OR (AOR)=3.12, 95% CI (1.90 to 5.13), family physician-dominant co-management AOR=3.39, 95% CI (1.94 to 5.93), specialist-dominant co-management AOR=2.01, 95% CI (1.23 to 3.26)). The odds of having one emergency department visit did not differ among models, although the odds of hospitalisation and HIV-specific hospitalisation were lower among patients who saw exclusively family physicians (AOR=0.23, 95% CI (0.14 to 0.35) and AOR=0.15, 95% CI (0.12 to 0.21)). The odds of antiretroviral prescriptions were lower among models in which patients' HIV care was provided predominantly by family physicians (exclusively primary care AOR=0.15, 95% CI (0.12 to 0.21), family physician-dominant co-management AOR=0.45, 95% CI (0.32 to 0.64)).
  
  
  CONCLUSIONS
  How care is provided had a potentially important influence on the quality of care delivered. Our key limitation is potential confounding due to the absence of HIV stage measures.
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Kendall
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Younger
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Hogg
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D015897:Comorbidity; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D004636:Emergency Service, Hospital; D005194:Family Practice; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D013038:Specialization; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Human Immunodeficiency Virus; PRIMARY CARE; chronic disease; comorbidity; health services delivery