Specialists More Likely to Recommend Appropriate Therapy

Specialists More Likely to Recommend Appropriate Therapy
Generalist physicians and those with little experience caring for HIV/AIDS patients need expert advice for the increasingly complex process of treating such patients, suggest the results of a survey of physicians in California, Florida, Massachusetts, and New York (AIDS Weekly Plus, June 11, 2001). The study, published in the Journal of General Internal Medicine (2001;16:360-368), adds another chapter in the debate over whether general physicians are qualified to treat HIV/AIDS patients. "Based on the data presented here, generalists in several high HIV prevalence states may not be prepared to provide state-of-the-art care for those with HIV/AIDS," said study author Valerie E. Stone, MD, MPH, of Brown University School of Medicine.

Stone and colleagues surveyed more than 1000 general physicians and infectious disease specialists about treatment recommendations for 2 hypothetical HIV patients. General internal medicine physicians were less likely than infectious disease specialists to recommend treatments consistent with guidelines from the Department of Health and Human Services and the International AIDS Society. Physicians with less HIV experience were also less likely to choose recommended therapies. However, those less knowledgeable about treatment guidelines appeared aware of the gaps in their knowledge. "Many generalists and those with less HIV experience indicated they would have referred the patients to another physician for management of HIV," Stone noted. "It should be emphasized that the generalists with moderate-to-high HIV experience in this study had high levels of knowledge and prescribing practices that were in line with current standards and essentially equivalent to those of the infectious disease physicians in the study," she said.

The researchers concluded that primary care physicians should consult an HIV expert when caring for HIV/AIDS patients if they feel they need treatment advice. "These results suggest physicians are able to gauge their own HIV competency and determine when there is a need for consultation," they wrote. [CDC HIV/STD/TB Prevention News Update, Thursday, June 14, 2001]