Landon Bruce E, Wilson Ira B, Wenger Neil S, Cohn Susan E, Fichtenbaum Carl J, Bozzette Samuel A, Shapiro Martin F, Cleary Paul D
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
J Gen Intern Med. 2002 Jan;17(1):12-22. doi: 10.1046/j.1525-1497.2002.10401.x.
To assess the association of specialty training and experience in the care of HIV disease with HIV-specific knowledge, referral patterns, and HIV-related education activities.
Cross-sectional survey.
The United States.
Physicians caring for patients in the HIV Costs and Service Utilization Study, a study of a probability sample of HIV-infected individuals in the United States.
Measures included physicians' reports of specialty training and HIV caseload, scores on an HIV-specific knowledge test, referral patterns, and attendance rates at HIV-related educational activities. Approximately 72% (379) of the eligible physicians completed a survey. Of these, 152 (40%) had infectious disease (ID) training, and 213 (56%) were generalists; 4% of ID-trained physicians and 37% of generalist physicians did not consider themselves HIV experts. The median current caseloads were 150 and 200 patients for ID experts and generalist experts, respectively. In contrast, the median caseload for non-expert generalists was 5. Mean scores on the knowledge scale were similar for ID and generalist experts (9.0 items correct out of 11 vs 8.5; P=not significant), but lower for generalist non-experts (6.5 items correct; P <.01). Experts had attended more local and national HIV meetings than non-experts (9.3 vs 2.7; P <.01, and 2.3 vs.40; P <.01, respectively) in the past year. Fewer ID experts ever referred than generalist experts (13.0% vs 27.3%; P=.01). In multivariable models that included specialty training and caseload, physicians with caseloads of 20 to 49 and >50 were more likely to have a high knowledge score (defined as 80% or more correct, odds ratio [OR], 2.8; P=.04 and OR, 5.7; P <.001, respectively), and the effect of specialty was attenuated (OR, 2.7; P=.02 decreased from OR, 7.8; P <.001 in a model without caseload). In the models predicting referral practices, both experience (OR,.25; P <.01 and OR,.17; P <.01 for caseloads of 20 to 49 and >50, respectively) and specialty (OR,.19; P <.01 and OR,.09; P <.01 for generalist and ID experts, respectively) were significant.
In a national sample of physicians, HIV-specific knowledge was more strongly associated with HIV caseload than with specialty training. In addition, although referral practices were related to both experience and specialty, generalist experts and ID physicians reported similar behaviors. This suggests that generalist physicians, through clinical experience and self-education, can develop specialized knowledge in HIV care.
评估艾滋病护理方面的专科培训和经验与艾滋病相关知识、转诊模式及艾滋病相关教育活动之间的关联。
横断面调查。
美国。
参与“艾滋病成本与服务利用研究”的医生，该研究对美国艾滋病感染者的概率样本进行了研究。
测量指标包括医生关于专科培训和艾滋病病例量的报告、艾滋病相关知识测试得分、转诊模式以及参加艾滋病相关教育活动的出勤率。约72%（379名）符合条件的医生完成了调查。其中，152名（40%）接受过传染病（ID）培训，213名（56%）为全科医生；4%接受过ID培训的医生和37%的全科医生不认为自己是艾滋病专家。ID专家和全科专家目前的病例量中位数分别为150例和200例。相比之下，非专家全科医生的病例量中位数为5例。ID专家和全科专家在知识量表上的平均得分相似（11题中答对9.0题对8.5题；P值无统计学意义），但非专家全科医生得分较低（答对6.5题；P<.01）。过去一年中，专家参加地方和全国性艾滋病会议的次数多于非专家（分别为9.3次对2.7次；P<.01，以及2.3次对0.40次；P<.01）。转诊的ID专家比全科专家少（13.0%对27.3%；P=.01）。在包含专科培训和病例量的多变量模型中，病例量为20至49例及>50例的医生更有可能获得高分（定义为80%或更高的正确率，优势比[OR]分别为2.8；P=.04和OR为5.7；P<.001），专科的影响减弱（OR为2.7；P=.02，在无病例量的模型中OR为7.8；P<.001）。在预测转诊行为的模型中，经验（病例量为20至49例及>50例时的OR分别为0.25；P<.01和OR为0.17；P<.01）和专科（全科专家和ID专家的OR分别为0.19；P<.01和OR为0.09；P<.01）均具有统计学意义。
在全国医生样本中，艾滋病相关知识与艾滋病病例量的关联比与专科培训的关联更强。此外，虽然转诊行为与经验和专科都有关，但全科专家和ID医生报告的行为相似。这表明全科医生通过临床经验和自我教育，可以在艾滋病护理方面积累专业知识。
