HIV Outcomes Related to Rural Physician Experience
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
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
"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
"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
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."
- In a recent survey, most rural primary care physicians had treated only one
or two HIV patients.
- Those who had treated 4 or more HIV patients were more likely to use the
latest advances in diagnostic procedures and drug treatments and have more
confidence in their skills.
- Experts recommend that HIV patients seek out doctors with the most HIV
experience in their area.