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A Model Clinic for the Initial Evaluation and Establishment of Primary Care for Persons Infected With Human Immunodeficiency Virus

A Model Clinic for the Initial Evaluation and Establishment of Primary Care for Persons Infected... Abstract Background: The human immunodeficiency virus (HIV)—infected patients on initial presentation to primary medical care may have extensive problems relating to medical, substance abuse, psychiatric, and social issues. We examined a model for the initiation of primary medical care for patients infected with HIV at a public hospital and presented the clinical, educational, and research benefits associated with such a clinic. Methods: Eight hundred forty-five consecutive HIV-infected outpatients without primary care, who presented to a municipal hospital HIV intake clinic, the Diagnostic Evaluation Unit, between February 1,1990 and August 31, 1993, received a multidisciplinary assessment and a facilitated access to medical services. The performance of standardized initial clinical evaluation and adherence to primary care referral were examined. Results: During the most recent study year, more than 90% of patients presenting to the clinic completed the intake process and 95% were seen at the site to which they were referred for primary medical care. Tests for CD4 lymphocytes, syphilis, hepatitis B, and tuberculosis were obtained, pneumococcal vaccinations were administered, and social service assessments were performed in 92% to 98% of patients completing the intake. The clinical setting was a site for involvement in research protocols and provided a focused educational experience concerning outpatient HIV management for medical students and residents. Conclusions: Establishment of a clinic dedicated to the initial evaluation of HIV-infected persons in a municipal hospital successfully evaluated and linked patients to primary care providers. The clinic structure enabled the standardized performance of appropriate laboratory tests and vaccinations and provided unique educational and research opportunities. We encourage other health care settings to consider the development of similar models for the initiation of medical care for persons infected with HIV.(Arch Intern Med. 1995;155:1629-1633) References 1. Centers for Disease Control and Prevention. HIV/AIDS Quarterly Surveillance Report . Atlanta, Ga: Centers for Disease Control and Prevention; 1993. 2. Centers for Disease Control. HIV prevalence estimates and AIDS case projections for the United States: report based on a workshop. MMWR Morb Mortal Wkly Rep . 1990:39:30. 3. Northfelt DW, Hayward RA, Shapiro MF. The acquired immunodeficiency syndrome is a primary care disease. Ann Intern Med . 1988;109:773-775.Crossref 4. Makadon HJ. Assessing HIV infection in primary care practice. J Gen Intern Med . 1991;6( (suppl) ):S2-S7.Crossref 5. Samet JH, Retondo MJ, Freedberg KA, Stein MD, Libman H. Factors associated with initiation of primary medical care for HIV-infected persons. Am J Med . 1994;97:347-353.Crossref 6. Katz MH, Bindman AB, Keane D, Chan AK. CD4 lymphocyte count as an indicator of delay in seeking HIV-related treatment. Arch Intern Med . 1992;152: 1501-1506.Crossref 7. Hutchinson CM, Wilson C, Reichart CA, Marsiglia VC, Zenilman JM, Hook EW III. CD4 lymphocyte concentrations in patients with newly identified HIV infection attending STD clinics. JAMA . 1991;266:253-256.Crossref 8. Gifford AL, McPhee SJ, Fordham D. Preventive care among HIV-positive patients in a general medical practice. Am J Prev Med . 1994;10:5-9. 9. Katz MH, Marx R, Hessol NA, Buchbinder SP, O'Malley P, Doll LS. Access to preventive medical care for men infected with human immunodeficiency virus (HIV). Clin Res . 1993;41:569A. 10. Curtis JR, Paauw DS, Wenrich MD, Carline JD, Ramsey PG. Physicians' ability to provide initial primary care to an HIV-infected patient. J Gen Intern Med . 1994;9( (suppl 2) ):50.Crossref 11. Libman H, Samet JH, Freedberg KA, Jain M, Craven DE. Referral to the community for continuing medical care of newly identified patients with human immunodeficiency virus infection: experience from a diagnostic evaluation unit. Clin Res . 1992;40:586A. 12. Freedberg KA, Malabanan A, Samet JH, Libman H. Initial assessment of patients infected with human immunodeficiency virus: the yield and cost of laboratory testing. J Acquir Immune Defic Syndr . 1994;7:1134-1140. 13. Poland GA, Love KR, Hughes CE. Routine immunization of the HIV-positive asymptomatic patient. J Gen Intern Med . 1990;5:147-152.Crossref 14. Craven DE, Fuller J, Barber T, Pelton S. Immunization of adults and children infected with human immunodeficiency virus. Infect Dis Clin Pract . 1992;1: 330-338, 411-423. 15. Orlander JD, Samet JH, Kazis L, Freedberg KA, Libman H. Improving medical residents' attitudes toward HIV-infected persons through training in an HIV staging and triage clinic. Acad Med . 1994;69:1001-1003.Crossref 16. Stone VE, Mauch MY, Steger K, Craven DE. Participation of women and persons of color in AIDS clinical trials. J Gen Intern Med . 1994;9( (suppl 2) ):108. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

A Model Clinic for the Initial Evaluation and Establishment of Primary Care for Persons Infected With Human Immunodeficiency Virus

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430150107011
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: The human immunodeficiency virus (HIV)—infected patients on initial presentation to primary medical care may have extensive problems relating to medical, substance abuse, psychiatric, and social issues. We examined a model for the initiation of primary medical care for patients infected with HIV at a public hospital and presented the clinical, educational, and research benefits associated with such a clinic. Methods: Eight hundred forty-five consecutive HIV-infected outpatients without primary care, who presented to a municipal hospital HIV intake clinic, the Diagnostic Evaluation Unit, between February 1,1990 and August 31, 1993, received a multidisciplinary assessment and a facilitated access to medical services. The performance of standardized initial clinical evaluation and adherence to primary care referral were examined. Results: During the most recent study year, more than 90% of patients presenting to the clinic completed the intake process and 95% were seen at the site to which they were referred for primary medical care. Tests for CD4 lymphocytes, syphilis, hepatitis B, and tuberculosis were obtained, pneumococcal vaccinations were administered, and social service assessments were performed in 92% to 98% of patients completing the intake. The clinical setting was a site for involvement in research protocols and provided a focused educational experience concerning outpatient HIV management for medical students and residents. Conclusions: Establishment of a clinic dedicated to the initial evaluation of HIV-infected persons in a municipal hospital successfully evaluated and linked patients to primary care providers. The clinic structure enabled the standardized performance of appropriate laboratory tests and vaccinations and provided unique educational and research opportunities. We encourage other health care settings to consider the development of similar models for the initiation of medical care for persons infected with HIV.(Arch Intern Med. 1995;155:1629-1633) References 1. Centers for Disease Control and Prevention. HIV/AIDS Quarterly Surveillance Report . Atlanta, Ga: Centers for Disease Control and Prevention; 1993. 2. Centers for Disease Control. HIV prevalence estimates and AIDS case projections for the United States: report based on a workshop. MMWR Morb Mortal Wkly Rep . 1990:39:30. 3. Northfelt DW, Hayward RA, Shapiro MF. The acquired immunodeficiency syndrome is a primary care disease. Ann Intern Med . 1988;109:773-775.Crossref 4. Makadon HJ. Assessing HIV infection in primary care practice. J Gen Intern Med . 1991;6( (suppl) ):S2-S7.Crossref 5. Samet JH, Retondo MJ, Freedberg KA, Stein MD, Libman H. Factors associated with initiation of primary medical care for HIV-infected persons. Am J Med . 1994;97:347-353.Crossref 6. Katz MH, Bindman AB, Keane D, Chan AK. CD4 lymphocyte count as an indicator of delay in seeking HIV-related treatment. Arch Intern Med . 1992;152: 1501-1506.Crossref 7. Hutchinson CM, Wilson C, Reichart CA, Marsiglia VC, Zenilman JM, Hook EW III. CD4 lymphocyte concentrations in patients with newly identified HIV infection attending STD clinics. JAMA . 1991;266:253-256.Crossref 8. Gifford AL, McPhee SJ, Fordham D. Preventive care among HIV-positive patients in a general medical practice. Am J Prev Med . 1994;10:5-9. 9. Katz MH, Marx R, Hessol NA, Buchbinder SP, O'Malley P, Doll LS. Access to preventive medical care for men infected with human immunodeficiency virus (HIV). Clin Res . 1993;41:569A. 10. Curtis JR, Paauw DS, Wenrich MD, Carline JD, Ramsey PG. Physicians' ability to provide initial primary care to an HIV-infected patient. J Gen Intern Med . 1994;9( (suppl 2) ):50.Crossref 11. Libman H, Samet JH, Freedberg KA, Jain M, Craven DE. Referral to the community for continuing medical care of newly identified patients with human immunodeficiency virus infection: experience from a diagnostic evaluation unit. Clin Res . 1992;40:586A. 12. Freedberg KA, Malabanan A, Samet JH, Libman H. Initial assessment of patients infected with human immunodeficiency virus: the yield and cost of laboratory testing. J Acquir Immune Defic Syndr . 1994;7:1134-1140. 13. Poland GA, Love KR, Hughes CE. Routine immunization of the HIV-positive asymptomatic patient. J Gen Intern Med . 1990;5:147-152.Crossref 14. Craven DE, Fuller J, Barber T, Pelton S. Immunization of adults and children infected with human immunodeficiency virus. Infect Dis Clin Pract . 1992;1: 330-338, 411-423. 15. Orlander JD, Samet JH, Kazis L, Freedberg KA, Libman H. Improving medical residents' attitudes toward HIV-infected persons through training in an HIV staging and triage clinic. Acad Med . 1994;69:1001-1003.Crossref 16. Stone VE, Mauch MY, Steger K, Craven DE. Participation of women and persons of color in AIDS clinical trials. J Gen Intern Med . 1994;9( (suppl 2) ):108.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 7, 1995

References