Is experience with human immunodeficiency virus disease related to clinical practice? A survey of rural primary care physicians

Background: Human immunodeficiency virus (HIV) disease is spreading to the rural United States, and medical care is increasingly provided by local pri mary care physicians. A volume-outcome relationship might exist in HIV care . However, little is known about the HIV experience and practices of rural primary care physicians. Objectives: To estimate the HIV experience of rural primary care physicians , and to determine whether experience is associated with use of newer manag ement strategies, confidence in care, and consultation needs. Design: Telephone survey of a random sample of primary care physicians. Setting: Primary care sites in nonmetropolitan California. Participants: One hundred twenty eligible primary care physicians in nonmet ropolitan California, with 102 respondents (85.0%). Main Outcome Measures: Physicians' HIV experience, use of protease inhibito rs and viral load tests, familiarity with vertical HIV transmission prophyl axis, confidence in HIV care, and consultation needs. Results: Most physicians were low-volume providers of HIV care and had limi ted knowledge of newer management strategies. Experience with protease inhi bitors and viral load tests was significantly related to number of recent p atients with HIV; 25.0% of those with 1 to 3 patients but 75.0% of those wi th 4 or more patients had prescribed protease inhibitors (P =.01), whereas 20.8% of those with 1 to 3 patients but 83.3% of those with 4 or more patie nts had used a viral load test (P =.001). Only 59.8% of all respondents, bu t 100.0% of those with 4 or more patients, were familiar with vertical HIV transmission prophylaxis (P =.001). After adjustment for other characterist ics, HIV experience remained significantly associated with use of newer man agement strategies (P =.01) and familiarity with vertical HIV transmission prophylaxis (P =.007). Physicians' confidence in HN care increased with exp erience (P =.006), and consultation needs decreased (P =.006). Conclusions: Primary care Physicians in rural California lacked in-depth ex perience with HIV disease. Experience was significantly associated with use of newer HIV management strategies, confidence, and consultation needs. Tr eating 4 or more patients with HIV or acquired immunodeficiency syndrome ma y be the threshold above which primary care physicians rapidly adopt new st rategies and have confidence in their care.