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The therapeutic management of HIV disease : concurrence with contemporary clinical guidelines among the physicians of British Columbia Heath, Katherine Valerie


Objectives: To describe patterns of knowledge regarding the therapeutic management of HIV-disease and concordance with therapeutic guidelines among three groups of British Columbian physicians and to identify possible determinants of these patterns Methods: Anonymous questionnaires were mailed to: all registrants of a province-wide HIV/AIDS drug treatment program (Group-G, n=659); all physicians who had a patient test HIV positive since 1989 (Group-H, n=816); and a random sample selected from the remaining physicians of British Columbia (Group-R, n=484). Questionnaires provided information about: physician demographic, personal and professional characteristics; level of current and total HIV-related experience; and knowledge of the use of therapeutic strategies including vaccinations, clinical tests, laboratory tests and antiretroviral therapy in the context of HIV patient care. An extended version of the survey sent to Group-G physicians requested additional information about the management of HIV-related opportunistic infections (OIs). Summary scores of patient care knowledge were computed by comparing physician responses to questions pertaining to knowledge of clinical management with recommendations made in contemporary therapeutic guidelines. Linear regression was used to identify associations between physician characteristics and knowledge scores. Results: Complete information was received from 38% of G-Group and 50% of Groups H and R, with limited demographic and experiential information obtained from a further 27%, 18% and 20% of groups G, H and R respectively. Multivariate analysis revealed a significant inverse relationship between physician knowledge and age in all groups (all p<0.02). Increased knowledge scores were also associated with the number of active HIV positive patients in groups G and H (all p<0.001) and lack of specialty training in groups H and R (all p< 0.001). Regarding the additional information gathered from Group-G respondents, physicians practising in Vancouver were more knowledgeable about 01 prophylaxis (p=0.047) while those with medical specialty training were more knowledgeable about the treatment of these illnesses (p=0.009). Conclusion: The data provides evidence of substantial heterogeneity in physician's preferred approaches to the therapeutic management of HIV disease and considerable deviation from contemporary guidelines. The level of concordance with these guidelines is associated with physician characteristics, most notably age, medical specially training and level of current HIV-related experience.

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