Combining specialist and primary health care teams for HIV positive patients: retrospective and prospective studies.

OBJECTIVE

To develop and evaluate a model of health care for HIV positive patients involving specialist, hospital based teams and primary health care teams.

DESIGN

One year retrospective and a 2 1/2 year prospective study.

SETTING

Two hospitals in West London and 88 general practitioners in 72 general hospitals.

SUBJECTS

209 adults with HIV infection.

INTERVENTION

General practitioners enrolled in the project were faxed structured outpatient clinic summaries. When hospital inpatients were discharged, a brief discharge summary was faxed. General practitioners had access to consultant physicians skilled in HIV medicine through a 24 hour mobile telephone service. An HIV/AIDS management and treatment guide containing relevant local information was produced. Quarterly discussion forums for general practitioners were held, and a regular newsletter was produced.

MAIN OUTCOME MEASURES

Hospital attendance and general practitioner consultations; perceived benefits and problems of patients and general practitioners.

RESULTS

The average length of a hospital inpatient stay was halved for those patients who had participated in the project for two years, and the average number of visits to the outpatient clinic per month fell for patients with AIDS. There was a substantial increase in the number of visits to general practitioners by patients with AIDS and symptomatic HIV infection. Patients and general practitioners both felt that the standard of health care provided had improved.

CONCLUSIONS

This model of health care efficiently and effectively utilised existing teams of hospital and primary health care professionals to provide care for HIV positive patients. Simple, prompt, and regular communication systems which provided information relevant to the needs of general practitioners were central to its success.