PHYSICIANS ABILITY TO PROVIDE INITIAL PRIMARY-CARE TO AN HIV-INFECTEDPATIENT

Background: Primary care physicians are providing care for an increasi ng number of persons infected with the human immunodeficiency virus (H IV). This study assesses the ability of primary care physicians to pro vide initial care for a patient with recently diagnosed HIV infection. Methods: A standardized patient (SP) was trained to portray an asympt omatic person with HIV infection seeking a primary care physician. Phy sicians took a medical history and counseled the SP; their performance s were assessed by the SP and through a brief written examination. In addition, physicians distributed questionnaires to HIV-infected patien ts in their practices to assess actual performance. The study particip ants consisted of 121 primary care physicians. Results: A minority of physicians recommended standard primary care screening tests and vacci nations, including viral hepatitis screening (35%), syphilis serologic testing (32%), and pneumococcal vaccination (23%). While most physici ans (87%) indicated they would obtain CD4 cell counts, only 50% indica ted they would start appropriate Pneumocystis carinii pneumonia prophy laxis. Although this patient presented documentation of a positive tub erculin skin test and no prior therapy for tuberculosis, only 53% of t he physicians recommended prophylactic isoniazid. While 75% of the phy sicians asked this SP about his HIV risk (sex with men), less than a t hird asked about condom use, number of sexual partners, or contact wit h previous sexual partners. Physicians with the most HIV experience we re more likely to recommend P carinii pneumonia prophylaxis, coinfecti on screening, pneumococcal vaccination, and isoniazid prophylactic the rapy. However, physicians' HIV experience was not associated with asse ssing this SP's risk of infecting others or with counseling regarding condom use. Questionnaires distributed to HIV-infected patients of the se physicians generally confirmed these findings. Conclusions: Basic H IV preventive and primary care may not be adequately performed by many primary care physicians. Physicians' HIV experience was associated wi th better performance of HIV primary care tasks, but not with screenin g and counseling concerning the spread of HIV infection.