Journal article
Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes
Open forum infectious diseases, Vol.4(1), pp.ofx005-ofx005
01/01/2017
DOI: 10.1093/ofid/ofx005
PMCID: PMC5413997
PMID: 28480278
Abstract
Abstract Background Care for people with human immunodeficiency virus (HIV) increasingly focuses on comorbidities, including hypertension. Evidence indicates that antiretroviral therapy and opportunistic infections are best managed by providers experienced in HIV medicine, but it is unclear how to structure comorbidity care. Approaches include providing comorbidity care in HIV clinics (“consolidated care”) or combining HIV care with comorbidity management in primary care clinics (“shared care”). We compared blood pressure (BP) control in HIV clinics practicing consolidated care versus shared care. Methods We created a national cohort of Veterans with HIV and hypertension receiving care in HIV clinics in Veterans Administration facilities and merged these data with a survey asking HIV providers how they delivered hypertension care (5794 Veterans in 73 clinics). We defined BP control as BP ≤140/90 mmHg on the most recent measure. We compared patients’ likelihood of experiencing BP control in clinics offering consolidated versus shared care, adjusting for patient and clinic characteristics. Results Forty-two of 73 clinics (57.5%) practiced consolidated care for hypertension. These clinics were larger and more likely to use multidisciplinary teams. The unadjusted frequency of BP control was 65.6% in consolidated care clinics vs 59.4% in shared care clinics (P < .01). The likelihood of BP control remained higher for patients in consolidated care clinics after adjusting for patient and clinic characteristics (odds ratio, 1.32; 95% confidence interval, 1.04–1.68). Conclusions Patients were more likely to experience BP control in clinics reporting consolidated care compared with clinics reporting shared care. For shared-care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.
Details
- Title: Subtitle
- Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes
- Creators
- A. Ben Appenheimer - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityBarbara Bokhour - Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MassachusettsD. Keith McInnes - Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MassachusettsKelly K Richardson - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, IowaAndrew L Thurman - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, IowaBrice F Beck - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, IowaMary Vaughan-Sarrazin - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CitySteven M Asch - Division of General Medical Science, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CaliforniaAmanda M Midboe - Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CaliforniaThom Taylor - Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CaliforniaKelly Dvorin - Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MassachusettsAllen L Gifford - Boston University School of Public Health, Department of Health Law, Policy, and Management, Massachusetts, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MassachusettsMichael E Ohl - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
- Resource Type
- Journal article
- Publication Details
- Open forum infectious diseases, Vol.4(1), pp.ofx005-ofx005
- DOI
- 10.1093/ofid/ofx005
- PMID
- 28480278
- PMCID
- PMC5413997
- NLM abbreviation
- Open Forum Infect Dis
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford University Press
- Grant note
- DOI: 10.13039/100007217, name: Health Services Research and Development, award: IIR 12–385
- Language
- English
- Date published
- 01/01/2017
- Academic Unit
- Psychiatry; Infectious Diseases; Health Management and Policy; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984064196102771
Metrics
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