Knowledge of care practices among clinicians who annually
treat <20 human immunodeficiency virus (HIV)-positive patients with
antiretroviral therapy (ART) is insufficient, despite their number, which is
likely to increase given shifting healthcare policies. We analyze the
practices, distribution and quality of care provided by low-volume prescribers
(LVPs) based on available data sources in New York State.
We communicated with 1278 (66%) of the LVPs identified
through a statewide claims database to determine the circumstances under which
they prescribed ART in federal fiscal year 2009. We reviewed patient records
from 84 LVPs who prescribed ART routinely and compared their performance with
that of experienced clinicians practicing in established HIV programs.
Of the surveyed LVPs, 368 (29%) provided routine ambulatory
care for 2323 persons living with HIV/AIDS, and 910 LVPs cited other reasons
for prescribing ART. Although the majority of LVPs (73%) practiced in New York
City, patients living upstate were more likely to be cared for by a LVP (odds
ratio, 1.7; 95% confidence interval, 1.4-1.9). Scores for basic HIV performance
measures, including viral suppression, were significantly higher in established
HIV programs than for providers who wrote prescriptions for <20 persons
living with HIV/AIDS (P < .01). We estimate that 33% of New York State
clinicians who provide ambulatory HIV care are LVPs.
Our findings suggest that the quality of care associated
with providers who prescribe ART for <20 patients is lower than that
provided by more experienced providers. Access to experienced providers as
defined by patient volume is an important determinant of delivering
high-quality care and should guide HIV workforce policy decisions.
Full article at: http://goo.gl/v8xOL0
By:
- 1New York State Department of Health AIDS Institute.
- 2Department of Medicine, Division of Infectious Diseases, Columbia University, and New York Presbyterian Hospital, New York.
More at: https://twitter.com/hiv_insight
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