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M94A2127.TXT
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1994-10-25
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Document 2127
DOCN M94A2127
TI Heterogeneity of clinical management of HIV disease decreases with
disease progression.
DT 9412
AU Sussel R; Hogg RS; Patullo AL; Schilder A; Goldstone IL; O'Shaughnessy
MV; British Columbia Centre for Excellence in HIV/AIDS, Vancouver,;
Canada.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):375 (abstract no. PD0106). Unique
Identifier : AIDSLINE ICA10/94370448
AB OBJECTIVE: To assess the determinants of clinical management of HIV
disease in adults. METHODS: Eligible participants had to (1) be
full-members (i.e. HIV positive) of the PWA Society of BC; (2) be
residents of BC; and (3) have previously agreed for the Society to send
them unsolicited material. Based on these criteria, self-administered
questionnaires were mailed out to 829 full-members. Information on
health care utilization and delivery, and clinical status was obtained.
Clinical management was assessed by tabulating whether specific tasks
were completed according to Canadian guidelines by health care
professionals at baseline history and routine follow-up. Baseline and
follow-up scores were calculated as the proportion of tasks actually
rendered and were adjusted according to disease stage and sex. RESULTS:
A total of 300 (36%) completed questionnaires were returned. The
majority of subjects were males (94%), aged between 30-49 years (79%),
residents of metro-Vancouver (80%), and had a CD4 count under 500 cells
(82%). The median baseline score was 50% (range 0-100%) and follow-up
score was 75% (range 0-100%). Of the 9 baseline tasks examined, one was
performed on more than 70% of subjects: CD4 count (74%). At follow-up, 7
out of 10 tasks were completed routinely in more 70% of subjects: doctor
visit at least every 6 months (96%), pap test in women (83%), dental
oral-exam (79%), blood chemistry (75%), and CD4 count (91%) at least
every year, and offered antiretroviral therapy (92%) when CD4 counts <
500 and PCP prophylaxis (94%) when CD4 < 200. Logistic regression
indicated that HIV test counseling by a physician (p = 0.0005) was a
predictor of baseline treatment score above the 70th percentile; while a
positive rating by the subject of support and care since diagnosis from
health care workers (p = 0.0001), low CD4 cell count (p = 0.012), and
Karnofsky score (p = 0.036) were predictors of follow-up scores above
the 70th percentile. CONCLUSIONS: Despite the availability of guidelines
for the management of HIV disease in adults, services actually rendered
to adults vary greatly within this province. Most notably, baseline care
is highly variable and the variability of appropriate follow-up care
lessens with those at later stages of HIV disease.
DE Adult Antiviral Agents/ADMINISTRATION & DOSAGE British Columbia
Combined Modality Therapy Comprehensive Health Care/*UTILIZATION
Female Human HIV Infections/IMMUNOLOGY/*THERAPY HIV
Seropositivity/IMMUNOLOGY/*THERAPY Leukocyte Count Male Middle Age
Patient Care Team/UTILIZATION Practice Guidelines *Quality Assurance,
Health Care T4 Lymphocytes/IMMUNOLOGY MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).