The association of hospital, clinic and provider volume with HIV/AIDS care and mortality: systematic review and meta-analysis

Handford, Curtis; Rackal, Julia; Tynan, Anne‐Marie; Rzeznikiewiz, Damian; Glazier, Richard H.

doi:10.1080/09540121.2011.608419

Cited by 28 publications

(20 citation statements)

References 28 publications

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“…Consistent with previous reviews with a similar focus (Handford, Rackal, Tynan, Rzeznikiewiz, & Glazier, 2012;Rackal et al, 2011), we found positive associations between health-care provider expertise and health outcomes among HIV-infected patients. However, our results regarding facility volume were less convincing than those in previously published reviews (Handford et al, 2012;Handford, Tynan, Rackal, & Glazier, 2006).…”

Section: Discussionsupporting

confidence: 80%

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Structure and quality of outpatient care for people living with an HIV infection

et al. 2016

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Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers.ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 80%

“…However, our results regarding facility volume were less convincing than those in previously published reviews (Handford et al, 2012;Handford, Tynan, Rackal, & Glazier, 2006). These reviews differ in the sense that they included many studies that took place before the introduction of cART.…”

Section: Discussioncontrasting

confidence: 56%

Structure and quality of outpatient care for people living with an HIV infection

et al. 2016

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“…With regards to health facility level factors, evidence suggests that hospital volume and provider training and experience improve outcomes in HIV-infected patients [20,21]. However, professionals involved in designing best practices for HIV outpatient care are largely dependent on results from studies predating the advent of cART, often performed in an inpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands

Engelhard

Smit²,

Sighem³

et al. 2016

Aids

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“…Our findings are consistent with those of a previous systematic review demonstrating that physician HIV experience is specifically associated with improved HIV-specific outcomes, such as adherence to ART prescribing. 2 Another review conducted by the same authors 3 attempted to distinguish physician training from physician HIV experience, and mainly concluded that both are important for HIV-specific outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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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The association of hospital, clinic and provider volume with HIV/AIDS care and mortality: systematic review and meta-analysis

Cited by 28 publications

References 28 publications

Structure and quality of outpatient care for people living with an HIV infection

Structure and quality of outpatient care for people living with an HIV infection

Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands

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

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