CLINIC SERVICES FOR PERSONS WITH AIDS - EXPERIENCE IN A HIGH-PREVALENCE STATE

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.