title: A population-based study evaluating family physicians' HIV experience and care of people living with HIV in Ontario.
abstract: OBJECTIVE
  Greater physician experience managing human immunodeficiency virus (HIV) infection has been associated with better HIV-specific outcomes. The objective of this study was to evaluate whether the HIV experience of a family physician modifies the association between the model of care delivery and the quality of care for people living with HIV.
  
  
  METHODS
  We retrospectively analyzed data from a population-based observational study conducted between April 1, 2009, and March 31, 2012. A total of 13,417 patients with HIV in Ontario were stratified into 5 possible patterns or models of care. We used multivariable hierarchical logistic regression analyses, adjusted for patient characteristics and pairwise comparisons, to evaluate the modification of the association between care model and indicators of quality of care (receipt of antiretroviral therapy, cancer screening, and health care use) by level of physician HIV experience (≤5, 6-49, ≥50 patients during study period).
  
  
  RESULTS
  The majority of HIV-positive patients (52.8%) saw family physicians exclusively for their care. Among these patients, receipt of antiretroviral therapy was significantly lower for those receiving care from family physicians with 5 or fewer patients and 6-49 patients compared with those with 50 or more patients (mean levels of adherence [95% CIs] were 0.34 [0.30-0.39] and 0.40 [0.34-0.45], respectively, vs 0.77 [0.74-0.80]). Patients' receipt of cancer screenings and health care use were unrelated to family physician HIV experience.
  
  
  CONCLUSIONS
  Family physician HIV experience was strongly associated with receipt of antiretroviral therapy by HIV-positive patients, especially among those seeing only family physicians for their care. Future work must determine the best models for integrating and delivering comprehensive HIV care among diverse populations and settings.
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 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada ckendall@uottawa.ca.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Kendall
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
authors.affiliation: 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, 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: 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
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000451:nursing*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D010821:Physicians, Family / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012189:Retrospective Studies
keywords: chronic disease; comorbidity; health services delivery; human immunodeficiency virus; primary care; specialists