Document 0746
 DOCN  M9470746
 TI    Implications of generalists' slow adoption of zidovudine in clinical
       practice.
 DT    9409
 AU    Markson LE; Cosler LE; Turner BJ; Center for Research in Medical
       Education and Health Care,; Jefferson Medical College, Philadelphia, Pa.
 SO    Arch Intern Med. 1994 Jul 11;154(13):1497-504. Unique Identifier :
       AIDSLINE MED/94288717
 AB    BACKGROUND: The lag time for adoption of new acquired immunodeficiency
       syndrome (AIDS) therapies into the clinical practices of different types
       of ambulatory care providers can be estimated from patient use of
       zidovudine therapy during the first few years after approval by the Food
       and Drug Administration. METHODS: We analyzed receipt of zidovudine
       therapy from April 1987 through March 1990 by 3643 patients with a
       diagnosis of AIDS. The study group was continuously enrolled in the New
       York State Medicaid program for at least 6 months after diagnosis. For
       each patient, the dominant providers of ambulatory care, receipt of
       zidovudine therapy, and consultation with a human immunodeficiency
       virus-AIDS specialist within 6 months after diagnosis were determined
       from Medicaid claims. AIDS specialists included physicians or clinics
       specializing in infectious disease or hematology/oncology or specific
       clinics within designated AIDS centers. RESULTS: In 1987, 55% of those
       who had an AIDS specialist as their dominant care provider received
       zidovudine therapy, compared with only 36% of patients with a primary
       care clinic as their dominant care provider. It was not until 1990, 3
       years after approval by the Food and Drug Administration, that the
       percentage of patients receiving zidovudine therapy (77% to 78%) was
       comparable for patients of primary care clinics and AIDS specialists. In
       logistic regression analysis, zidovudine use did not differ between
       patients of AIDS specialists and patients with other types of dominant
       providers when the latter group had consulted with an AIDS specialist
       (adjusted odds ratio, 1.38; 95% confidence interval, 0.99 to 1.95).
       CONCLUSIONS: In our AIDS study population, there was at least a 3-year
       lag before patients of primary care clinics received zidovudine therapy
       at the same rate as patients of AIDS specialists. Conditions such as
       AIDS with rapid changes in treatment options may require a close
       relationship between generalists and specialists to increase access to
       new therapies.
 DE    Acquired Immunodeficiency Syndrome/*DRUG THERAPY  Adolescence  Adult
       Female  Human  Logistic Models  Male  Middle Age  *Physician's Practice
       Patterns  *Physicians, Family  Support, U.S. Gov't, P.H.S.  Survival
       Analysis  Time Factors  Zidovudine/*THERAPEUTIC USE  JOURNAL ARTICLE

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