Ve. Stone et al., Relation of physician specialty and HIV/AIDS experience to choice of guideline-recommended antiretroviral therapy, J GEN INT M, 16(6), 2001, pp. 360-368
Background: Controversy exists regarding who should provide care for those
with HIV/AIDS. While previous studies have found an association between phy
sician HIV experience and patient outcomes, less is known about the relatio
nship of physician specialty to HIV/AIDS outcomes or quality of care.
Objective: To examine the relationship between choice of appropriate antire
troviral therapy (ART) to physician specialty and HIV/AIDS experience.
Design: Self-administered physician survey.
Participants: Random sample of 2,478 internal medicine (IM) and infectious
disease (ID) physicians.
Measurements: Choice of guideline-recommended ART.
Results: Two patients with HIV disease, differing only by CD4+ count and HI
V RNA load, were presented, Respondents were asked whether ART was indicate
d, and if so, what ART regimen they would choose. Respondents' ART choices
were categorized as "recommended" or not by Department of Health and Human
Services guidelines. Respondents' HIV/AIDS experience was categorized as mo
derate to high (MOD/HI) or none to low (NO/LO). For Case 1, 72.9% of respon
ding physicians chose recommended ART. Recommended ART was more Likely (P<.
01) to be chosen by ID physicians (88.2%) than by IM physicians (57.1%). Ph
ysicians with MOD/HI experience were also more likely (P <.01) to choose re
commended ART than those with NO/LO experience. Finally, choice of ART was
examined using logistic regression: specialty and HIV experience were found
to be independent predictors of choosing recommended ART (for ID physician
s, odds ratio [OR], 4.66; 95% confidence interval [95% CI], 3.15 to 6.90; a
nd for MOD/HI experience, OR, 2.05; 95% CI, 1.33 to 3.16). Results for Case
2 were similar. When the analysis was repeated excluding physicians who in
dicated they would refer the HIV "patient," specialty and HIV experience we
re not significant predictors of choosing recommended ART.
Conclusions: Guideline-recommended ART appears to be less likely to be chos
en by generalists and physicians with less HIV/AIDS experience, although ma
ny of these physicians report they would refer these patients in clinical p
ractice. These results lend support to current recommendations for routine
expert consultant input in the management of those with HIV/AIDS.