HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs. hospital-based specialty care in the Bronx, New York.
AIDS Care. 2010 Sep 6;:1-8
Authors: Chu C, Umanski G, Blank A, Grossberg R, Selwyn PA
The HIV-infected population in the USA is expanding as patients survive longer and new infections are identified. In many areas, particularly rural/medically underserved regions, there is a growing shortage of providers with sufficient HIV expertise. HIV services incorporated into community-based (CB), primary care settings may therefore improve the distribution and delivery of HIV treatment. Our objective was to describe/compare patients and treatment outcomes in two settings: a community-located, primary care-based HIV program, and a hospital-based (HB) specialty center. CB providers had on-site access to generalist HIV experts. The hospital center was staffed primarily by infectious disease physicians. This was a retrospective cohort study of 854 HIV-positive adults initiating care between 1/2005 and 12/2007 within an academic medical center network in the Bronx, NY. Treatment outcomes were virologic and immunologic response at 16-32 and 48 weeks, respectively, after combination antiretroviral therapy (cART) initiation. We found that HB subjects presented with a higher prevalence of AIDS (59% vs. 46%, p<0.01) and lower initial CD4 (385 vs. 437, p<0.05) than CB subjects. Among 178 community vs. 237 hospital subjects starting cART, 66% vs. 62% achieved virologic suppression (95% confidence interval (CI) difference -0.14-0.06) and 49% vs. 59% achieved immunologic success, defined as a 100 cell/mm(3) increase in CD4 (95% CI difference 0.00-0.19). The multivariate-adjusted likelihoods of achieving viral suppression [OR=1.24 (95% CI 0.69-2.33)] and immunologic success [OR=0.76 (95% CI 0.47-1.21)] were not statistically significant for community vs. hospital subjects. Because this was an observational study, propensity scores were used to address potential selection bias when subjects presented to a particular setting. In conclusion, HIV-infected patients initiate care at CB clinics earlier and with less advanced HIV disease. Treatment outcomes are comparable to those at a HB specialty center, suggesting that HIV care can be delivered effectively in community settings.
20824549
– HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs….
A response to patient-initiated aggression in general practice: Australian professional medical organisations face a challenge.
Aust J Prim Health. 2010 Sep;16(3):252-259
Authors: Ceramidas DM, Parker R
Little is known about the incidence, prevalence, and impact of patient-initiated aggression against general practice staff in Australia or how medically related professional organisations respond to this. The few available Australian studies suggest that up to about two-thirds of Australian GPs experience patient-initiated aggression within a 12-month period. This paper reports on relevant professional stakeholder organisations’ perceptions of and response to aggression perpetrated against their members working in Australian general practices. Thirteen organisations each nominated a representative to undertake a one-off semi-structured interview. Respondents informed the study findings from organisational, practice level, and Divisions of General Practice perspectives. While all professional organisations were cognisant of the presence of violence and aggression in Australian general practice, very few offered proactive measures in the management of difficult or aggressive patients, or practical support to their members. Organisations with fewer members involved in general practice were overall more supportive and proactive with regard to education, training, and publications than were organisations with a greater proportion of their membership involved in general practice settings. Respondents believed the current socio-political climate provided opportunity for a greater organisational response, but there was uncertainty regarding the appropriate response in view of a lack of evidence base.
20815996
– A response to patient-initiated aggression in general practice: Australian professional medical organisations face a…
Investigating referral pathways from primary care to consumer health organisations.
Aust J Prim Health. 2010 Sep;16(3):260-267
Authors: Young CE, Mutch AJ, Boyle FM, Dean JH
While chronic disease places an increasing burden on Australia’s primary care system it is unrealistic to expect GPs to meet the range of support needs experienced by patients managing chronic conditions. Consumer health organisations (CHO) have the potential to augment clinical care by providing a variety of supportive services; however, they are underutilised by patients and GPs. This qualitative study investigates GPs’ knowledge and perceptions of CHO and their contributions to chronic disease care. The study involved semi-structured interviews with 10 GPs. Overall, participants demonstrated clear understanding of the role of CHO in chronic disease management, but a critical finding was the way GPs’ view of their own chronic care role appears to influence referral practices. GPs operating in a traditional role were less likely to refer to CHO than those who had adopted a chronic care approach. A second key finding related to GPs’ views of Diabetes Australia. All GPs identified this organisation as an important referral point, providing some reassurance that CHO can be integrated into the primary care sector. Further research is needed to determine how the ‘definite advantages’ associated with Diabetes Australia can be used to extend GP referral and enhance the health system’s integration of other CHO.
20815997
– Investigating referral pathways from primary care to consumer health organisations.
