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Previous Volume 334:701-707 March 14, 1996 Number 11 Next

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ABSTRACT

Background Previous studies have found that patients with the acquired immunodeficiency syndrome (AIDS) who are admitted to hospitals that admit many such patients have lower mortality rates than patients in hospitals with less experience with AIDS. We examined the relation between physicians' experience with AIDS and the survival of their patients with AIDS.

Methods We studied 403 adult male patients enrolled in a staff-model health maintenance organization in whom first AIDS-defining illnesses were diagnosed from 1984 through mid-1994; we determined that these illnesses met the 1987 case definition of the Centers for Disease Control. We defined three levels of experience for the patients' 125 primary care physicians according to their experience with AIDS during residency training and the cumulative number of patients with AIDS they had cared for in their practices.

Results The median survival of the patients of physicians with the least experience in the management of AIDS was 14 months, as compared with 26 months for the patients of physicians with the most experience (P<0.001). Controlling for the severity of illness and the year of diagnosis, we found that the patients cared for by physicians with the most experience had a 31 percent lower risk of death than the patients cared for by physicians with the least experience (P<0.02). Among 244 patients with an AIDS-defining illness diagnosed from 1989 through 1994, after adjustment for the CD4+ cell count and the severity of illness, the risk of death was 43 percent lower for patients of the most experienced physicians than for patients of the least experienced (P<0.02).

Conclusions The experience of primary care physicians in the management of AIDS is significantly associated with survival among their patients.

Source Information

From the Departments of Medicine (M.M.K., T.D.K., R.A.D., C.L.M.), Health Services (T.D.K., R.A.D., E.H.W.), and Epidemiology (T.D.K.), University of Washington; and the Center for Health Studies (E.H.W.), Group Health Cooperative of Puget Sound (W.T.D.) — all in Seattle.

Address reprint requests to Dr. Kitahata at the University of Washington, Center for AIDS and STD, 1001 Broadway, Suite 215, Seattle, WA 98122.

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Physicians' Experience and Survival in Patients with AIDS
Coker R. J., Poznansky M. C., Bach P. B., Guerra-Romero L., Vazquez F. P., Macher A. M., Goosby E. P., Kitahata M. M., Maxwell C. L., Volberding P. A.
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N Engl J Med 1996; 335:349-351, Aug 1, 1996. Correspondence

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