IMPLICATIONS OF GENERALISTS SLOW ADOPTION OF ZIDOVUDINE IN CLINICAL-PRACTICE

Background: The lag time for adoption of new acquired immunodeficiency syndrome (AIDS) therapies into the clinical practices of different ty pes of ambulatory care providers can be estimated from patient use of zidovudine therapy during the first few years after approval by the Fo od and Drug Administration. Methods: We analyzed receipt of zidovudine therapy from April 1987 through March 1990 by 3643 patients with a di agnosis of AIDS. The study group was continuously enrolled in the New York State Medicaid program for at least 6 months after diagnosis. For each patient, the dominant providers of ambulatory care, receipt of z idovudine therapy, and consultation with a human immunodeficiency viru s-AIDS specialist within 6 months after diagnosis were determined from Medicaid claims. AIDS specialists included physicians or clinics spec ializing in infectious disease or hematology/oncology or specific clin ics within designated AIDS centers. Results: In 1987, 55% of those who had an AIDS specialist as their dominant care provider received zidov udine therapy, compared with only 36% of patients with a primary care clinic as their dominant care provider. It was not until 1990, 3 years after approval by the Food and Drug Administration, that the percenta ge of patients receiving zidovudine therapy (77% to 78%) was comparabl e for patients of primary care clinics and AIDS specialists. In logist ic regression analysis, zidovudine use did not differ between patients of AIDS specialists and patients with other types of dominant provide rs when the latter group had consulted with an AIDS specialist (adjust ed odds ratio, 1.38; 95% confidence interval, 0.99 to 1.95). Conclusio ns: In our AIDS study population, there was at least a 3-year lag befo re patients of primary care clinics received zidovudine therapy at the same rate as patients of AIDS specialists. Conditions such as AIDS wi th rapid changes in treatment options may require a close relationship between generalists and specialists to increase access to new therapi es.