Document 0708
 DOCN  M95A0708
 TI    Physicians' ability to provide initial primary care to an HIV-infected
       patient.
 DT    9510
 AU    Curtis JR; Paauw DS; Wenrich MD; Carline JD; Ramsey PG; Department of
       Medicine, University of Washington, Seattle, USA.
 SO    Arch Intern Med. 1995 Aug 7-21;155(15):1613-8. Unique Identifier :
       AIDSLINE MED/95344293
 AB    BACKGROUND: Primary care physicians are providing care for an increasing
       number of persons infected with the human immunodeficiency virus (HIV).
       This study assesses the ability of primary care physicians to provide
       initial care for a patient with recently diagnosed HIV infection.
       METHODS: A standardized patient (SP) was trained to portray an
       asymptomatic person with HIV infection seeking a primary care physician.
       Physicians took a medical history and counseled the SP; their
       performances were assessed by the SP and through a brief written
       examination. In addition, physicians distributed questionnaires to
       HIV-infected patients in their practices to assess actual performance.
       The study participants consisted of 121 primary care physicians.
       RESULTS: A minority of physicians recommended standard primary care
       screening tests and vaccinations, including viral hepatitis screening
       (35%), syphilis serologic testing (32%), and pneumococcal vaccination
       (23%). While most physicians (87%) indicated they would obtain CD4 cell
       counts, only 50% indicated they would start appropriate Pneumocystis
       carinii pneumonia prophylaxis. Although this patient presented
       documentation of a positive tuberculin skin test and no prior therapy
       for tuberculosis, only 53% of the physicians recommended prophylactic
       isoniazid. While 75% of the physicians asked this SP about condom use,
       number of sexual partners, or contact with previous sexual partners.
       Physicians with the most HIV experience were more likely to recommended
       P carinii pneumonia prophylaxis, coinfection screening, pneumococcal
       vaccination, and isoniazid prophylactic therapy. However, physicians'
       HIV experience was not associated with assessing this SP's risk of
       infecting others or with counseling regarding condom use. Questionnaires
       distributed to HIV-infected patients of these physicians generally
       confirmed these findings. CONCLUSIONS: Basic HIV preventive and primary
       care may not be adequately performed by many primary care physicians.
       Physicians' HIV experience was associated with better performance of HIV
       primary care tasks, but not with screening and counseling concerning the
       spread of HIV infection.
 DE    Counseling  Family Practice/*STANDARDS  Human  HIV
       Infections/DIAGNOSIS/*THERAPY  Mass Screening  Northwestern United
       States  Primary Health Care/*STANDARDS  Questionnaires  Referral and
       Consultation  Support, Non-U.S. Gov't  Support, U.S. Gov't, P.H.S.
       JOURNAL ARTICLE

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