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Family physician HIV experience associated with ART receipt

A retrospective analysis of data from a population-based observational study demonstrated that the HIV experience of family physicians is associated with HIV-related quality of care outcomes.

Claire E. Kendall, MD, MSc, department of family medicine, University of Ottawa, Ontario, and colleagues reported in the Annals of Family Medicine that patients who were HIV-positive were more likely to receive antiretroviral therapy (ART) from family physicians with more HIV experience.

The researchers used the Ontario Health Insurance Plan billing claims system to identify 13,417 patients with HIV who received care in Ontario. Of those patients, 11,427 met inclusion criteria and were included in analyses that assessed care models and quality of care.

Results showed that the majority of patients who were HIV-positive received their care exclusively from family physicians (52.8%), compared with patients who received their care via comanagement with specialist (47.2%). Of patients who received their care exclusively from family physicians, receipt of ART increased if family physicians cared for 50 or more patients with HIV (mean ART adherence = 0.77; 95% CI, 0.74-0.8) compared with family physicians who cared for six to 49 patients with HIV (0.4; 95% CI, 0.34-0.45) and family physicians who cared for five or fewer patients with HIV (0.34; 95% CI, 0.3-0.39).

"Because we also found that this influence of family physician HIV experience is mitigated by having an HIV specialist within their model of care, in order to ensure adequate ART prescribing, care delivery models for people with HIV should include either an HIV specialist or a family physician with considerable HIV experience," Kendall and colleagues wrote. "We recommend that such access to HIV expertise, whether through direct contact with HIV specialists or through strategies that give decision support to family physicians, be provided within a collaborative model that allows patients to retain continuity with their family physicians to ensure a comprehensive approach to care delivery." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.