Women with AIDS found to have 50 percent better chance of survival when treated at clinics with high levels of experience in advanced HIV treatment than at less experienced clinics.
Researchers from Jefferson Medical College of Thomas Jefferson University, Philadelphia, and the New York State Department of Health have found an association between clinic experience with advanced HIV treatment and survival of women with AIDS. An analysis of outpatient clinic treatment of 887 Medicaid-enrolled women diagnosed with AIDS between 1986 and 1992 in New York, the state with the largest number of women with AIDS in the United States, showed that women who received treatment in clinics with a high experience level in treating HIV had a 50 percent better chance of survival than women treated at less experienced clinics. Study results appear in the March issue of the journal AIDS.
"The results of our study suggest that physicians and health professionals who treat a certain illness more frequently may do it better," said Christine Laine, M.D., M.P.H., lead author of the study and assistant professor of Medicine, division of Internal Medicine, Jefferson Medical College of Thomas Jefferson University. "This is especially true in regards to HIV management and treatment, since therapy is advancing so rapidly."
Researchers gauged the experience level of 117 New York State clinics, defined as hospital outpatient practices, large physician groups or community health centers, by counting the number of patients with HIV who used each clinic as their usual source of care prior to AIDS diagnosis. Larger patient volumes indicated more experienced clinics.
"Previous research in this area calculated experience by collecting self-reports from doctors who estimated the number of HIV infected patients they had treated," explained Dr. Laine. "Using Medicaid records, we counted the number of patients with HIV treated at each clinic rather than relying on providers’ rough estimates."
The study is also unique in that it is the first to examine clinic experience and survival of women with AIDS. According to Dr. Laine, previous research examined physician experience and survival of men with AIDS in a single staff model health maintenance organization.
"We believe that our research is an important complement to this earlier work since it focuses on a female population. There is concern that women with HIV may receive less good care than men, often being less likely to receive antiretroviral therapy and more commonly treated in facilities with less experience with HIV. Our findings at the clinic level are also an important addition to earlier findings at the hospital and physician levels since many individuals with HIV infection are members of vulnerable populations and receive care in clinic settings."
Researchers also looked at the demographic and clinical characteristics of the patient sample as well as establishing the date of each patient’s AIDS diagnosis and disease severity at that time. Adjusting for these variables, 71 percent of patients in high experience clinics were alive 21 months after diagnosis compared with 53 percent in low experience clinics.
"Our results serve as another piece of the puzzle in understanding the relationship between provider experience and quality of care for vulnerable populations afflicted with HIV," said Dr. Laine. "The next step will be to identify specialized services offered by experienced clinics that may contribute to their success."
Journal
AIDS