title: Does general practice deliver safe primary care to people living with HIV? A case-notes review.
abstract: BACKGROUND
  Safe care in general practice for people living with HIV requires early diagnosis of undetected infection and safe co-prescribing with antiretroviral therapy (ART).
  
  
  OBJECTIVE
  To evaluate safe co-prescribing in general practice patients who are taking ART, and to describe missed diagnostic opportunities for undiagnosed HIV infection in primary care.
  
  
  METHODS
  Retrospective case-notes review in general practices within NHS City and Hackney Primary Care Trust (PCT), London, UK.
  
  
  METHODS
  All general practices in NHS City and Hackney PCT were invited to participate. Patients known to be HIV positive were identified using Read Codes. Each practice undertook retrospective case-notes reviews on specialist correspondence, coding of ART, prescribing of common contraindicated drug pairings, and missed opportunities for HIV diagnosis.
  
  
  RESULTS
  In total, 31/44 (70.5%) practices participated, and 1022 people living with HIV were identified. Practices had received HIV clinic letters for 698 of those 1022 (68.3%) patients in the previous 12 months. Of the 787 patients known to be prescribed ART, only 413 (52.5%) had correct drug codes recorded; 32/787 (4.1%) were receiving specified contraindicated drug pairings. In total, 89 patients were eligible for their case-notes to undergo a retrospective review of occurrences that took place pre-diagnosis. In the 2 years preceding diagnosis, these 89 had attended 716 face-to-face GP consultations, of which 123 (17.2%) were for indicator conditions. Fifty-one of these patients (57.3%) presented at least once with an indicator condition (interquartile range 1-3; median 2).
  
  
  CONCLUSIONS
  In a large-scale evaluation of GP records of people living with HIV, gaps in ART recording and co-prescribing were identified, and evidence demonstrated missed opportunities for diagnosis within general practice. Specialists and generalists must communicate better to enhance safe prescribing and reduce delayed diagnosis.
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Rosie
authors.initials: R
authors.lastname: Wellesley
authors.affiliation: NHS City and Hackney PCT, London.
authors.forename: Alice
authors.initials: A
authors.lastname: Whittle
authors.affiliation: NHS City and Hackney PCT, London.
authors.forename: Jose
authors.initials: J
authors.lastname: Figueroa
authors.affiliation: Centre for the Study of Sexual Health and HIV;
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Jonathan Mann Centre, Homerton University Hospital NHS Foundation Trust, London.
authors.forename: Richard
authors.initials: R
authors.lastname: Castles
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Boomla
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: Centre for Primary Care and Public Health, Queen Mary University of London, London.
authors.forename: Werner
authors.initials: W
authors.lastname: Leber
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D057210:Delayed Diagnosis; D004347:Drug Interactions; D042241:Early Diagnosis; D058006:General Practice / Q000458:organization & administration / Q000592:standards*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London / Q000453:epidemiology; D016347:Medical Records Systems, Computerized; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; delayed diagnosis; drug interactions; general practice; inappropriate prescribing