艾滋病患者转诊模式的转变。

Fournier Phillip O, Savageau Judith A, Baldor Robert A

University of Massachusetts Medical School, Worcester, MA 01655, USA.

J Fam Pract. 2008 Feb;57(2):E1-9.

PURPOSE

With the rapid development (and complex prescribing patterns) of drugs for HIV/AIDS care, it is challenging for physicians to keep current. We conducted a follow-up study to a 1994 cohort study to see how care and referral patterns have changed over the last decade. In this study, we examined how family physicians in Massachusetts were caring for their HIV-infected patients, and to see whether FPs were referring more patients to specialists for care compared with a decade ago.

METHODS

We designed a cross-sectional survey as an 11-year follow-up to a previous study. It was mailed in 2005 to the active membership of the Massachusetts Academy of Family Physicians.

RESULTS

Compared with the cohort of 1994, the number of HIV+ patients in individual practices remained about the same, but the number of practices with no AIDS patients was significantly higher. 85.3% of FPs noted that they were more likely to refer HIV/AIDS patients immediately compared with their own practice patterns a decade ago. In this study, 39.0% of current respondents referred HIV+ patients immediately, 57.0% co-managed patients, and 4.1% managed these patients alone (the data for the 1994 cohort was 7.0%, 45.8%, and 47.2%, respectively; P<.0001). Similar changes were seen in regard to care patterns for AIDS patients. Among the current cohort, 61.7% reported that they referred patients immediately, compared with only 18.3% in 1994; 36.8% noted that they co-managed these patients (vs 74.3% in 1994); and only 1.5% reported that they managed these patients alone (vs 7.4% in 1994; P<.0001).

CONCLUSIONS

A significant shift amongst FPs with regard to their referral patterns for patients with HIV/AIDS has occurred over the last decade. The community health center has emerged as a resource for patients with HIV/AIDS. Funding for specific training programs on HIV/AIDS care should be targeted to community health centers.

目的

随着用于艾滋病护理的药物迅速发展（以及复杂的处方模式），医生要跟上形势颇具挑战。我们对1994年的一项队列研究进行了随访研究，以了解在过去十年中护理和转诊模式发生了怎样的变化。在这项研究中，我们调查了马萨诸塞州的家庭医生是如何护理他们的艾滋病毒感染患者的，以及与十年前相比，家庭医生是否将更多患者转诊给专科医生进行护理。

方法

我们设计了一项横断面调查，作为对先前一项研究的11年随访。该调查于2005年邮寄给马萨诸塞州家庭医生学会的活跃会员。

结果

与1994年的队列相比，个体诊所中艾滋病毒阳性患者的数量基本保持不变，但没有艾滋病患者的诊所数量显著增加。85.3%的家庭医生指出，与十年前他们自己的执业模式相比，他们更有可能立即转诊艾滋病毒/艾滋病患者。在这项研究中，39.0%的当前受访者立即转诊艾滋病毒阳性患者，57.0%共同管理患者，4.1%单独管理这些患者（1994年队列的数据分别为7.0%、45.8%和47.2%；P<0.0001）。在艾滋病患者的护理模式方面也出现了类似的变化。在当前队列中，61.7%的人报告他们立即转诊患者，而1994年只有18.3%；36.8%的人指出他们共同管理这些患者（1994年为74.3%）；只有1.5%的人报告他们单独管理这些患者（1994年为7.4%；P<0.0001）。