Curtis J R, Paauw D S, Wenrich M D, Carline J D, Ramsey P G
Department of Medicine, University of Washington, Seattle, USA.
Arch Intern Med. 1995;155(15):1613-8.
Primary care physicians are providing care for an increasing number of persons infected with the human immunodeficiency virus (HIV). This study assesses the ability of primary care physicians to provide initial care for a patient with recently diagnosed HIV infection.
A standardized patient (SP) was trained to portray an asymptomatic person with HIV infection seeking a primary care physician. Physicians took a medical history and counseled the SP; their performances were assessed by the SP and through a brief written examination. In addition, physicians distributed questionnaires to HIV-infected patients in their practices to assess actual performance. The study participants consisted of 121 primary care physicians.
A minority of physicians recommended standard primary care screening tests and vaccinations, including viral hepatitis screening (35%), syphilis serologic testing (32%), and pneumococcal vaccination (23%). While most physicians (87%) indicated they would obtain CD4 cell counts, only 50% indicated they would start appropriate Pneumocystis carinii pneumonia prophylaxis. Although this patient presented documentation of a positive tuberculin skin test and no prior therapy for tuberculosis, only 53% of the physicians recommended prophylactic isoniazid. While 75% of the physicians asked this SP about condom use, number of sexual partners, or contact with previous sexual partners. Physicians with the most HIV experience were more likely to recommended P carinii pneumonia prophylaxis, coinfection screening, pneumococcal vaccination, and isoniazid prophylactic therapy. However, physicians' HIV experience was not associated with assessing this SP's risk of infecting others or with counseling regarding condom use. Questionnaires distributed to HIV-infected patients of these physicians generally confirmed these findings.
Basic HIV preventive and primary care may not be adequately performed by many primary care physicians. Physicians' HIV experience was associated with better performance of HIV primary care tasks, but not with screening and counseling concerning the spread of HIV infection.
基层医疗医生正在为越来越多的感染人类免疫缺陷病毒（HIV）的患者提供治疗。本研究评估基层医疗医生为最近诊断出感染HIV的患者提供初始治疗的能力。
一名标准化患者（SP）接受培训，以扮演一名寻求基层医疗医生的无症状HIV感染者。医生采集病史并为SP提供咨询；他们的表现由SP评估并通过简短的书面考试进行评估。此外，医生在其诊所向HIV感染患者分发问卷，以评估实际表现。研究参与者包括121名基层医疗医生。
少数医生推荐了标准的基层医疗筛查测试和疫苗接种，包括病毒性肝炎筛查（35%）、梅毒血清学检测（32%）和肺炎球菌疫苗接种（23%）。虽然大多数医生（87%）表示他们会获取CD4细胞计数，但只有50%表示他们会开始适当的卡氏肺孢子虫肺炎预防。尽管该患者提供了结核菌素皮肤试验阳性的记录且既往未接受过结核病治疗，但只有53%的医生推荐预防性使用异烟肼。虽然75%的医生询问了该SP关于避孕套使用、性伴侣数量或与以前性伴侣接触的情况。有最多HIV治疗经验的医生更有可能推荐卡氏肺孢子虫肺炎预防、合并感染筛查、肺炎球菌疫苗接种和异烟肼预防性治疗。然而，医生的HIV治疗经验与评估该SP感染他人的风险或与避孕套使用咨询无关。向这些医生的HIV感染患者分发的问卷总体上证实了这些发现。
许多基层医疗医生可能未充分开展基本的HIV预防和基层医疗工作。医生的HIV治疗经验与更好地完成HIV基层医疗任务相关，但与HIV感染传播的筛查和咨询无关。
