Quality of generalist vs. speciality care for people with HIV on antiretroviral treatment: a prospective cohort study

Page, Julie; Weber, Rainer; Somaini, Bertino; Nöstlinger, C; Donath, K; Jaccard, René

doi:10.1046/j.1468-1293.2003.00157.x

Cited by 30 publications

(45 citation statements)

References 28 publications

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“…This view was supported by another two prospective cohort studies. Page et al, (2003) examined quality of generalist vs. specialty care for people with HIV on antiretroviral treatments and Smith et al, (1996) explored the development and evaluation of a model of health care for HIV positive patients involving specialist, hospital based teams and primary care health teams. Page et al, (2003) found that general practitioners can provide equally adequate care with access to knowledge specific to HIV treatment.…”

Section: Empirical Studiesmentioning

confidence: 99%

“…Page et al, (2003) examined quality of generalist vs. specialty care for people with HIV on antiretroviral treatments and Smith et al, (1996) explored the development and evaluation of a model of health care for HIV positive patients involving specialist, hospital based teams and primary care health teams. Page et al, (2003) found that general practitioners can provide equally adequate care with access to knowledge specific to HIV treatment. This was supported in Smith et al', (1996: 419) work who went to great lengths to point out that, '[their] aim was not to turn general practitioners into experts in HIV medicine who could then initiate and supervise specialist treatment regimes.…”

Section: Empirical Studiesmentioning

confidence: 99%

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Reflections on the history of general practice in Australia

Harris

Zwar

2014

Medical Journal of Australia

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Summary General practice has experienced change over the past century driven by a variety of influences, the most important of which have been changes in the health needs of the population, the organisation of the workforce, and medicine itself. Over this time, general practice has developed as a profession through education and, ultimately, recognition of its specialist qualifications. There has been increasing organisational sophistication at the practice, regional and national levels. Despite contested scope of practice and vision of its future, general practice's place in the health system as a whole has been increasingly recognised and affirmed.

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Section: Empirical Studiesmentioning

confidence: 99%

Section: Empirical Studiesmentioning

confidence: 99%

Reflections on the history of general practice in Australia

Harris

Zwar

2014

Medical Journal of Australia

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“…Twelve studies addressed the prevention of infectious diseases, especially influenza by providing vaccinations [11][12][13][14][15][16][17][18][19][20][21][22] or by performing a specific diagnostic test. 22 For clinical topics, most prevention activities addressed cardiovascular disease prevention, [23][24][25][26][27][28][29][30] cancer screening, [31][32][33][34] HIV, [35][36][37] prevention of osteoporosis, 38,39 addiction prevention, 40,41 and others [42][43][44][45][46][47] (Table 2). The most common observed intervention was counseling on lifestyle changes with twelve studies.…”

Section: Description Of Studiesmentioning

confidence: 99%

Screening and prevention in Swiss primary care: a systematic review

Eisner

Zoller²,

Rosemann³

et al. 2011

IJGM

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Background and objectives Prevention is a challenging area of primary care. In Switzerland, little is known about attitudes to and performance of screening and prevention services in general practice. To implement prevention services in primary care it is important to know about not only potential facilitators but also barriers. Primary care encompasses the activities of general practitioners, including those with particular interest and/or specializations (eg, pediatrics, gynecology). The aim of this study was to review all studies with a focus on prevention services which have been conducted in Switzerland and to reveal barriers and facilitators for physicians to participate in any preventive measures. Methods The Cochrane Library, PubMed, EMBASE and BIOSIS were searched from January 1990 through December 2010. Studies focussing on preventive activities in primary care settings were selected and reviewed. The methodological quality of the identified studies was classified according to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement. Results We identified 49 studies including 45 descriptive studies and four randomised controlled trials (RCTs). Twelve studies addressed the prevention of epidemics, eleven out of them vaccinations. Further studies focused on lifestyle changes, physical activity counselling, smoking cessation, cardiovascular prevention and cancer screening. Perceived lack of knowledge/training and lack of time were the most commonly stated barriers. Motivation, feasibility and efficiency were the most frequently reported supporting factors for preventive activities. The methodological quality was weak, only one out of four RCTs met the applied quality criteria. Conclusion Most studies focussing on screening and prevention activities in primary care addressed vaccination, lifestyle modification or cardiovascular disease prevention. Identified barriers and facilitators indicate a need for primary-care-adapted education and training which are easy to handle, time-saving and reflect the specific needs of general practitioners. If new prevention programs are to be implemented in general practices, RCTs of high methodological quality are needed to assess their impact.

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“…[10][11][12][13][14][15][16][17][18] There is increasing recognition that the management of HIV requires a primary care presence, but we have a poor understanding of how to integrate HIV-specific expertise within a primary care context. 7,10,[14][15][16][17][18][19][20][21] Overall, it has been difficult to distinguish the respective contributions of physician qualification and physician experience of care to the effectiveness of HIV care. 3 We have previously used routinely collected administrative data to develop and characterize an intuitive typology of shared care for people with HIV based on actual patterns of care.…”

Section: Introductionmentioning

confidence: 99%

A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

Kendall

Dujovny

Younger

et al. 2015

The Annals of Family Medicine

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PURPOSE Greater physician experience managing human immunodeficiency virus (HIV) infection has been associated with better HIV-specific outcomes. The objective of this study was to evaluate whether the HIV experience of a family physician modifies the association between the model of care delivery and the quality of care for people living with HIV. METHODSWe retrospectively analyzed data from a population-based observational study conducted between April 1, 2009, and March 31, 2012. A total of 13,417 patients with HIV in Ontario were stratified into 5 possible patterns or models of care. We used multivariable hierarchical logistic regression analyses, adjusted for patient characteristics and pairwise comparisons, to evaluate the modification of the association between care model and indicators of quality of care (receipt of antiretroviral therapy, cancer screening, and health care use) by level of physician HIV experience (≤5, 6-49, ≥50 patients during study period). RESULTSThe majority of HIV-positive patients (52.8%) saw family physicians exclusively for their care. Among these patients, receipt of antiretroviral therapy was significantly lower for those receiving care from family physicians with 5 or fewer patients and 6-49 patients compared with those with 50 or more patients CONCLUSIONS Family physician HIV experience was strongly associated with receipt of antiretroviral therapy by HIV-positive patients, especially among those seeing only family physicians for their care. Future work must determine the best models for integrating and delivering comprehensive HIV care among diverse populations and settings. Ann Fam Med 2015;13:436-445. doi: 10.1370/afm.1822. INTRODUCTIONA ntiretroviral therapy (ART) has substantially reduced the mortality and morbidity arising from human immunodeficiency virus (HIV) infection, thus shifting the care needs of people living with longstanding HIV. Evidence suggests that clinicians with more HIV training, HIV experience, or both provide higher quality of care as measured by disease-specific indicators, including ART prescribing. [1][2][3][4][5][6] Many of these studies, however, were performed early in the ART era, when both disease and treatments were novel and complex. Recent work has found similar quality of HIV-specific care between generalist and specialist physicians, even though the HIV experience of these physicians varied. 7,8 In addition, multidisciplinary care teams with nonexpert family physicians may improve patients' ART adherence more than HIV specialist care alone. 9 Another important consideration is that specialist HIV physicians are less adept than generalists at preventing and managing the common comorbidities emerging with increased HIV longevity. [10][11][12][13][14][15][16][17][18] increasing recognition that the management of HIV requires a primary care presence, but we have a poor understanding of how to integrate HIV-specific expertise within a primary care context. 7,10,[14][15][16][17][18][19][20][21] Overall, it has been difficult to distin...

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Quality of generalist vs. speciality care for people with HIV on antiretroviral treatment: a prospective cohort study

Abstract: A well-working system offers high-quality healthcare to persons living with HIV, where existing teams of specialty and primary health-care professionals efficiently and effectively co-operate.

Cited by 30 publications

References 28 publications

Reflections on the history of general practice in Australia

Reflections on the history of general practice in Australia

Screening and prevention in Swiss primary care: a systematic review

A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

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