Primary care delivery is associated with greater physician experience and improved survival among persons with AIDS

Mari M. Kitahata, Stephen E. Van Rompaey, Peter W. Dillingham, Thomas D. Koepsell, Richard (Rick) Deyo, Wayne Dodge, Edward H. Wagner

Research output: Contribution to journalArticle

70 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)95-103
Number of pages9
JournalJournal of General Internal Medicine
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2003
Externally publishedYes

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Primary Health Care
Acquired Immunodeficiency Syndrome
Physicians
Survival
Primary Care Physicians
Highly Active Antiretroviral Therapy
HIV
Pharmaceutical Services
Health Maintenance Organizations
Patient Care
Cohort Studies
Outpatients
Retrospective Studies
Population

Keywords

  • HIV
  • Outcome and process assessment health care
  • Physician's practice patterns

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Primary care delivery is associated with greater physician experience and improved survival among persons with AIDS. / Kitahata, Mari M.; Van Rompaey, Stephen E.; Dillingham, Peter W.; Koepsell, Thomas D.; Deyo, Richard (Rick); Dodge, Wayne; Wagner, Edward H.

In: Journal of General Internal Medicine, Vol. 18, No. 2, 01.02.2003, p. 95-103.

Research output: Contribution to journalArticle

Kitahata, Mari M. ; Van Rompaey, Stephen E. ; Dillingham, Peter W. ; Koepsell, Thomas D. ; Deyo, Richard (Rick) ; Dodge, Wayne ; Wagner, Edward H. / Primary care delivery is associated with greater physician experience and improved survival among persons with AIDS. In: Journal of General Internal Medicine. 2003 ; Vol. 18, No. 2. pp. 95-103.
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