COMBINING SPECIALIST AND PRIMARY HEALTH-CARE TEAMS FOR HIV-POSITIVE PATIENTS - RETROSPECTIVE AND PROSPECTIVE STUDIES

Objective-To develop and evaluate a model of health care for HIV posit ive patients involving specialist, hospital based teams and primary he alth care teams.Design-One year retrospective and 2 1/2 year prospecti ve study. Setting-Two hospitals in west London and 88 general practiti oners in 72 general practices. Subjects-209 adults with HIV infection. Intervention-General practitioners enrolled in the project were fared structured outpatient clinic summaries. When hospital inpatients were discharged, a brief discharge summary was fared. General practitioner s had access to consultant physicians skilled in HIV medicine through a 24 hour mobile telephone service. An HIV/AIDS management and treatme nt guide containing relevant local information was produced. Quarterly discussion forums for general practitioners were held, and a regular newsletter was produced. Main outcome measures-Hospital attendance and general practitioner consultations; perceived benefits and problems o f patients and general practitioners. Results-The average length of a hospital inpatient stay was halved for those patients who had particip ated in the project for two years, and the average number of visits to the outpatient clinic per month fell for patients with AIDS. There wa s a substantial increase in the number of visits to general practition ers by patients with AIDS and symptomatic HIV infection. Patients and general practitioners both felt that the standard of health care provi ded had improved. Conclusions-This model of health care efficiently an d effectively utilised existing teams of hospital and primary health c are professionals to provide care for HIV positive patients. Simple, p rompt, and regular communication systems which provided information re levant to the needs of general practitioners were central to its succe ss.