Document 2127
 DOCN  M94A2127
 TI    Heterogeneity of clinical management of HIV disease decreases with
       disease progression.
 DT    9412
 AU    Sussel R; Hogg RS; Patullo AL; Schilder A; Goldstone IL; O'Shaughnessy
       MV; British Columbia Centre for Excellence in HIV/AIDS, Vancouver,;
       Canada.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):375 (abstract no. PD0106). Unique
       Identifier : AIDSLINE ICA10/94370448
 AB    OBJECTIVE: To assess the determinants of clinical management of HIV
       disease in adults. METHODS: Eligible participants had to (1) be
       full-members (i.e. HIV positive) of the PWA Society of BC; (2) be
       residents of BC; and (3) have previously agreed for the Society to send
       them unsolicited material. Based on these criteria, self-administered
       questionnaires were mailed out to 829 full-members. Information on
       health care utilization and delivery, and clinical status was obtained.
       Clinical management was assessed by tabulating whether specific tasks
       were completed according to Canadian guidelines by health care
       professionals at baseline history and routine follow-up. Baseline and
       follow-up scores were calculated as the proportion of tasks actually
       rendered and were adjusted according to disease stage and sex. RESULTS:
       A total of 300 (36%) completed questionnaires were returned. The
       majority of subjects were males (94%), aged between 30-49 years (79%),
       residents of metro-Vancouver (80%), and had a CD4 count under 500 cells
       (82%). The median baseline score was 50% (range 0-100%) and follow-up
       score was 75% (range 0-100%). Of the 9 baseline tasks examined, one was
       performed on more than 70% of subjects: CD4 count (74%). At follow-up, 7
       out of 10 tasks were completed routinely in more 70% of subjects: doctor
       visit at least every 6 months (96%), pap test in women (83%), dental
       oral-exam (79%), blood chemistry (75%), and CD4 count (91%) at least
       every year, and offered antiretroviral therapy (92%) when CD4 counts <
       500 and PCP prophylaxis (94%) when CD4 < 200. Logistic regression
       indicated that HIV test counseling by a physician (p = 0.0005) was a
       predictor of baseline treatment score above the 70th percentile; while a
       positive rating by the subject of support and care since diagnosis from
       health care workers (p = 0.0001), low CD4 cell count (p = 0.012), and
       Karnofsky score (p = 0.036) were predictors of follow-up scores above
       the 70th percentile. CONCLUSIONS: Despite the availability of guidelines
       for the management of HIV disease in adults, services actually rendered
       to adults vary greatly within this province. Most notably, baseline care
       is highly variable and the variability of appropriate follow-up care
       lessens with those at later stages of HIV disease.
 DE    Adult  Antiviral Agents/ADMINISTRATION & DOSAGE  British Columbia
       Combined Modality Therapy  Comprehensive Health Care/*UTILIZATION
       Female  Human  HIV Infections/IMMUNOLOGY/*THERAPY  HIV
       Seropositivity/IMMUNOLOGY/*THERAPY  Leukocyte Count  Male  Middle Age
       Patient Care Team/UTILIZATION  Practice Guidelines  *Quality Assurance,
       Health Care  T4 Lymphocytes/IMMUNOLOGY  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).