Le. Markson et al., CLINIC SERVICES FOR PERSONS WITH AIDS - EXPERIENCE IN A HIGH-PREVALENCE STATE, Journal of general internal medicine, 12(3), 1997, pp. 141-149
OBJECTIVE: To profile characteristics of clinics caring for persons wi
th advanced HIV infection, DESIGN AND SETTING: Survey of clinic direct
ors in New York State. PARTICIPANTS: Newly diagnosed Medicaid-enrolled
AIDS patients in New York state in federal fiscal years 1987-1992 (n
= 6,184) managed by 62 HIV specialty, 53 hospital-based general medici
ne/primary care, 36 community-based primary care, and 28 other clinics
. MEASUREMENTS AND MAIN RESULTS: Telephone survey about clinic hours,
emphasis on HIV, staffing, procedures, and directors' rating of care,
Estimates of the number of newly diagnosed, Medicaid-enrolled AIDS pat
ients treated in surveyed clinics were obtained from claims data, We f
ound that community-based clinics were significantly more likely to ha
ve longer hours, a physician on call, or to accommodate unscheduled ca
re than were hospital-based general medicine/primary care or other typ
es of clinics. Compared with HIV specialty clinics, general medicine/p
rimary care clinics were less likely to have HIV-specific care attribu
tes such as a director of HIV care (98% vs 72%), multidisciplinary con
ferences on HIV care (83% vs 32%), or a standard initial HIV workup (9
0% vs 70%). Of general medicine/primary care clinics, most (83%) were
staffed by residents and fellows compared with only 68% of HIV or 25%
of community-based clinics (p < .001), General medicine/primary care c
linics were less likely than community-based clinics to perform Pap sm
ears (75% vs 94%) or to have case managers on payroll (21% vs 81%). CO
NCLUSIONS: In this sample of clinics, hospital-based general medicine/
primary care clinics managing the care of Medicaid enrollees with AIDS
appeared to have more limited hours and availability of specific serv
ices than HIV specialty or community-based clinics.