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Clinicians infrequently prescribing ART provide lower quality of HIV care
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Clinicians who prescribe ART fewer than 20 times each year may be providing lower quality care to HIV patients than practitioners frequently recommending the therapy, according to recently reported data.
“The complexities of [ART] demand criteria that identify clinicians with sufficient expertise to provide high-quality, long-term HIV care,” the researchers wrote. “Ensuring that all providers who routinely manage care for HIV-positive patients have the required competencies and capabilities to provide high-quality care is a critical and timely component for achieving population-wide viral load suppression.”
Using Medicaid and AIDS Drug Assistance Program claims for prescription drugs, the researchers identified clinicians within the state of New York prescribing ART to fewer than 20 patients in 2009. Researchers attempted to contact these low-volume providers (LVPs) for information such as caseload or ART prescription strategies, resulting in a cohort of 368 confirmed LVPs for whom data were available. Further, performance scores based on clinical outcomes were derived from medical records provided by 84 LVPs and compared with those collected from a statewide cohort of experienced providers.
Reasons for ART prescription reported by confirmed and unconfirmed LVPs included covering gaps in care (45%), providing inpatient care (20%), treatment for hepatitis B (13%) and post-exposure prophylaxis (8%). Routine ambulatory care was provided for 2,323 HIV patients treated by confirmed LVPs, resulting in a mean of 4.3 patients prescribed ART by this group over the course of 1 year. Common specialties among confirmed LVPs included internal medicine (41%), family medicine (31%) and infectious disease (6.8%), with only four providers identifying themselves as HIV specialists.
Medical chart comparisons revealed lower scores for LVPs among all indications of HIV care, most notably viral load suppression (56% vs. 77%; P < .001). Other examined areas included viral load measurement every 4 or 6 months (P < .001), biannual CD4+ T-cell count measurement (P < .001) and screening for syphilis (P < .001) or mental health (P < .001).
“With the eventual retirement of providers who have delivered HIV care since the beginning of the epidemic, unfilled positions within infectious diseases fellowship programs, and perceived lack of young providers expressing interest in HIV care, the urgency of developing workforce policies to assure high-quality care must be addressed by policymakers and educators in the health professions,” the researchers wrote. “Our results suggest that these approaches will need to consider how sufficient experience in the use of ART can be acquired to achieve maximal viral suppression rates among [persons living with HIV/AIDS], which, in turn, will reduce onward transmission.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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