Primary Care Delivery Is Associated With Greater Physician Experience and Improved Survival Among Persons with AIDS

doi:10.1046/j.1525-1497.2003.11049.x

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Wiley InterScience

Journal of General Internal Medicine

Volume 18 Issue 2, Pages 95 - 103

Published Online: 28 Jan 2003

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Primary Care Delivery Is Associated With Greater Physician Experience and Improved Survival Among Persons with AIDS

Mari M. Kitahata, MD, MPH , Stephen E. Van Rompaey, PhD , Peter W. Dillingham, MS , Thomas D. Koepsell, MD, MPH , Richard A. Deyo, MD, MPH , Wayne Dodge, MD, MPH , Edward H. Wagner, MD, MPH

Received from the Departments of Medicine (MMK, SEV, PWD, TDK, RAD), Health Services (MMK, TDK, RAD, EHW), and Epidemiology (TDK), University of Washington, Seattle, Wash; and the Center for Health Studies, GHC Cooperative of Puget Sound (WD, EHW), Seattle, Wash.

Address correspondence and requests for reprints to Dr. Kitahata: University of Washington Center for AIDS Research, HMC, Box 359931, 325 9th Ave., Seattle, WA 98104 (e-mail: kitahata@u.washington.edu).

Presented in part at the 7th Conference on Retroviruses and Opportunistic Infections, February 2000, San Francisco, Calif.

KEYWORDS

HIV • outcome and process assessment health care • physician's practice patterns

ABSTRACT

OBJECTIVE:It has been shown that greater physician experience in the care of persons with AIDS prolongs survival, but how more experienced primary care physicians achieve better outcomes is not known.

DESIGN/SETTING/PATIENTS:Retrospective cohort study of HIV-infected patients enrolled in a large staff-model health maintenance organization from 1990 through 1999.

MEASUREMENTS:Adjusted odds of medical service delivery and adjusted hazard ratio of death by physician experience level (least, moderate, most) and service utilization.

MAIN RESULTS:Primary care delivery by physicians with greater AIDS experience was associated with improved survival. After controlling for disease severity, patients cared for by the most experienced physicians were twice as likely to receive a primary care visit in a given month compared with patients of the least and moderately experienced physicians (P < .01). Patients of the least experienced physicians received the lowest level of outpatient pharmacy and laboratory services (P < .001) and were half as likely to have a specialty care visit compared with patients of the most and moderately experienced physicians (P < .05). Patients who received infrequent primary care visits by the least experienced physicians were 15.3 times more likely to die than patients of the most experienced physicians (P = .02). There was a significant increase in primary care services delivered to the population of HIV-infected patients receiving care in 1999, when highly active antiretroviral therapy (HAART) was in general use, compared with the time period prior to the introduction of HAART.

CONCLUSIONS:Primary care delivery by physicians with greater HIV experience contributes to improved patient outcomes.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1046/j.1525-1497.2003.11049.x About DOI