The Case for Primary Care Clinicians in HIV Care

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The Case for Primary Care Clinicians in HIV Care
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• Should we be PMDs to HIV patients?
• Can we or will we have to?
• Better and more efficient utilization of
  Specialists

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Division of Care

• HIV physicians have had focused medical practices
• As medical conditions in the elderly accumulate
  who will manage the care
• Multiple clinicians / difficulty with
  coordination of care / drug treatments and
  interactions
• Will first generation HIV clinicians retire
  leaving a care gap?

Oh, and this piece of information many newly
diagnosed HIV patients already have primary care
clinicians
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Too many patients
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Unlike us, they are aging

• 27 of people living with AIDS in the US are
  older than 50
• Numbers of cases expected to increase with
  increasing survival under treatment

National Association on HIV Over Fifty
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Our Patients Are Aging
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Leading Causes of Death in Elderly US
CDC
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Cultural Competency of Current Clinicians
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Can Our Specialists Afford to Deliver Primary HIV
Care?
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Additional funding flat and moving
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Funding

• Public funding drives HIV care from specialists
• Public funding rises from 37 to 50
  to 62 from asymptomatic to
  symptomatic to AIDS

Schur, C.L., and Berk, M.L. Health Insurance
Coverage of Persons With HIV-Related Illness
Data From the ACSUS Screener
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Practice Set-up of AAHIVM dues Paying Members
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• Demographics
• Increasing numbers
• Increasing age of patients
• Causes of death
• Sources of insurance
• Makeup of HIV clinicians
• HIV specific care
• Increasing capabilities
• Technology
• Funding

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Complexity of HIV Care

• Regimens and potency
• Technology

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Regimen Complexity?HIV
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Type II Diabetes
Aspirin
Insulin
Glitizone
Sulfonylurea
ACE
Statin
Metformin
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Technology

• Better medications
• Communications technology
• Working with patients / HIV specialists
• Resolving drug interactions
• Regulating visits and labs
• Electronic medical records

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Rapid Onset and Durable Antiretroviral Effect of
Raltegravir (MK-0518), a Novel HIV-1 Integrase
Inhibitor, as Part of Combination ART in
TreatmentNaïve HIV-1 Infected Patients 48 Week
Data
Markowitz et al. 4th IAS 2007Oral TUAB104.
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Cooperative Care of Patients