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HIV Outcomes Related to Rural Physician Experience

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Dec. 2, 1999 (Atlanta) -- Treating four or more patients with HIV may be the threshold at which rural primary care physicians adopt new strategies and have confidence in their skills, according to a study in the November/December issue of the journal Archives ofFamily Medicine. Experts say meeting this learning curve is critical to HIV outcomes in rural areas.

The study, which surveyed 102 primary care physicians in rural California, tracked the number of HIV patients treated in response to some troubling reports. Several studies suggested that primary care physicians are unable to diagnose and treat some HIV-related conditions. These findings are important given that HIV is increasing in rural areas where specialists are harder to find.

Although 60% of those surveyed had been in practice over 17 years, most had treated only one or two HIV patients. But physicians who had treated four or more were significantly more likely to use the latest advances in diagnostic testing and drug therapy. They were also more likely to feel confident about their HIV care and less likely to consult with other physicians.

"It's commendable that rural primary care physicians are providing this level of HIV care," says Cindy Willard, MD, the chief investigator and family practitioner at University Hospital in Salt Lake City. "These doctors are taking on a disease that's new and frightening to them, and they're getting up to speed quickly." When it comes to HIV, Willard says experience counts more than specialty qualifications, and others seem inclined to agree.

"In managing complex diseases like HIV, research shows that clinical experience is the critical factor," says Mari Kitahata, MD, an internist and assistant professor of medicine at the University of Washington in Seattle. "Patients should choose the physician with the most HIV experience whether they're an internist or a family practitioner." As further evidence, the Department of Health and Human Services recently advised HIV treatment by physicians with extensive HIV experience, and this may already be happening through referrals.

"Some of the rural California docs were referring HIV patients to colleagues with the most HIV experience," says Marjorie Bowman, MD, MPA, who chairs the department of family practice and community medicine at the University of Pennsylvania in Philadelphia. "Referrals between practices are a great way to develop a wide range of local expertise in rural areas."

Although these findings are reassuring, Willard says their interpretation is limited. "The data rely on verbal reports because we didn't measure patient outcomes and referral patterns directly. So a true causal relationship can't be determined with this particular design. Still, we're encouraged by the trends we've observed in rural HIV care."

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