General practice

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

^a Department of Infectious Diseases, Royal Postgraduate Medical School, Hammersmith Hospital, London W12 0NN, ^b Medical Statistics Unit, Royal Postgraduate Medical School, ^c The Grove Medical Practice, Northolt, Middlesex, ^d The Cameron Centre, Ealing Hospital, London

Correspondence to: Dr Shaunak.

Abstract

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 2 1/2 year prospective study.
Setting: Two hospitals in west London and 88 general practitioners in 72 general practices.
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.

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