Sheikh Kabir, Rangan Sheela, Deshmukh Deepali, Dholakia Yatin, Porter John
Centre for Health Research and Development, Maharashtra Association of Anthropological Sciences, 64/5, Anand Park, Aundh, Pune 411007, Maharashtra, India.
Natl Med J India. 2005 Jan-Feb;18(1):32-6.
The private medical sector is an important source of healthcare in India. Increasingly, concerns have been raised about its role in the care of patients with HIV/AIDS. Evidence about private practitioners' existing management practices will help to create policies addressing this sector.
A central urban area of Pune city was selected for its high density of healthcare facilities. Private practitioners in the area were interviewed using a structured interview schedule. Based on a 1-year recall period, the schedule covered different aspects of the practitioners' HIV/AIDS management practices including diagnosis, treatment and referral.
Of the 215 practitioners interviewed, 66% had tested and diagnosed HIV infection. Fifty-four per cent had been consulted by HIV-infected clients 'shopping' for alternative diagnoses or treatment. Overall, 75% of the respondents had been consulted by HIV-infected clients for treatment. Of these, 14% had prescribed antiretroviral drugs, sometimes without adequate knowledge of the guidelines for their use. Other supportive and symptomatic treatments were also frequently prescribed. Private practitioners commonly referred HIV-infected clients for management to other private doctors, or to public hospitals. There were variations in respondents' practices by sex and system of medicine.
Private practitioners are actively involved in diagnosing and managing patients with HIV/AIDS. Some of their management practices are inappropriate and need to be remedied. There are also concerns about gaps in the continuity of care of HIV-infected persons, for which networks between providers need to be strengthened. Public-private partnerships must be created to improve the flow of information to private practitioners, and Include them in the national health framework.
私立医疗部门是印度医疗保健的重要来源。人们越来越关注其在艾滋病毒/艾滋病患者护理中的作用。有关私人执业医生现有管理做法的证据将有助于制定针对该部门的政策。
浦那市的一个中心城区因其高密度的医疗设施而被选中。使用结构化访谈提纲对该地区的私人执业医生进行访谈。基于1年的回顾期，提纲涵盖了执业医生艾滋病毒/艾滋病管理做法的不同方面，包括诊断、治疗和转诊。
在接受访谈的215名执业医生中，66%进行过艾滋病毒感染检测和诊断。54%曾接待过寻求其他诊断或治疗的艾滋病毒感染患者前来咨询。总体而言，75%的受访者曾接待过艾滋病毒感染患者前来咨询治疗。其中，14%曾开具抗逆转录病毒药物，有时对其使用指南了解不足。其他支持性和对症治疗也经常被开具。私人执业医生通常会将艾滋病毒感染患者转介给其他私人医生或公立医院进行管理。受访者的做法在性别和医学体系方面存在差异。
私人执业医生积极参与艾滋病毒/艾滋病患者的诊断和管理。他们的一些管理做法不恰当，需要加以纠正。对于艾滋病毒感染者护理连续性方面的差距也存在担忧，为此需要加强提供者之间的网络。必须建立公私伙伴关系，以改善向私人执业医生的信息流通，并将他们纳入国家卫生框架。
