Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Mo.B.1 163 - Mo.B.l 168

Monday, July 8, 1996

Mo.B.l 163
PRIMARY CARE VS. SUBSPECIALISTS' QUESTIONS OF AN HIV TELEPHONE
CONSULTATION SERVICE
Liljestrand, Petra, Goldschmidt R. Balano K, Moy A, Legg J, Dong B, Leoung G. University of
California, San Francisco, USA.
Objective: To compare primary care vs. subspecialists' usage of the National HIV Telephone
Consultation Service.
Methods: The HRSA/AIDS ETC National HIV Telephone Consultation Service provides HIV
education and clinical consultation for health-care providers. Data on physician callers
(N=2,292), calls (N=4,486), encounters (N=6,206), and patients (N=3,300) were analyzed
using a Chi square statistic.
Results: Inquiries by primary care physicians differed significantly (p <.001) from those of
subspecialists.The former had a greater number of patient specific questions (73% vs. 56%),
and more questions about the management of specific clinical symptoms (21% vs. I15%) as
well as drug therapies generally (20% vs. I15%), while fewer questions about HIV prevention
and transmission (5% vs. 10%) and HIV exposures in the workplace (3% vs. I 1%).
Significantly more primary care providers worked in community clinics (28% vs. 8%), while a
smaller number worked in hospitals (13% vs. 28%). More primary care providers worked in
rural communities (25% vs. I14%; p <.002), with a lower HIV+ patient count and level of
HIV experience.
Conclusions: The calls to this service shed light on physicians' "consciously recognized"
needs for HIV information. Primary care physicians, including those who have little experience with HIV, have more patient-specific management questions and fewer inquiries about
prevention and transmission than do subspecialists.They represent a less urban and less
hospital-based group than their subspecialist counterparts, and have a smaller HIV patient
load. Attempts to address primary care and subspecialty physician needs for HIV information could profit from these data.
Petra Liljestrand. CPAT SF General Hospital, Bldg 80, Ward 83, San Francisco, CA 941 10 Tel:
(4 I 5) 476-7 I 64. Fax: [phone]. Email: [email protected]
Mo.B.I 164
OCCUPATIONAL THERAPY: BEDSIDE EVALUATION AND TREATMENT OF
DYSPHAGIA FOR PEOPLE WITH HIV DISEASE IN THE HOSPITAL
Chan, Ri Sau Kuen, Ilaria Gerard, Jacobs Jonathan. The Center for Special Studies, NewYork
Hospital - Cornell Medical Center, NYC, NY USA
Issue: Patients hospitalized with HIV disease present with a variety of conditions resulting in
dysphagia.
Project: Diagnoses such as progressive multifocal leukoencephalopathy (PML), toxoplasmosis, cerebrovascular accidents, central nervous system lymphoma, and encephalitis can lead
to cognitive changes, decreased oral control, and/or pharyngeal impairments which affect
the patient's ability to swallow safely In addition, the patient's medical status may inhibit participation in a video esophagram. A standardized dysphagia evaluation at The New York
Hospital-Cornell Medical Center which assesses the patient's cognitive status, respiratory
status, physical abilities, oral and pharyngeal control, and presence of reflexes can guide the
occupational therapist in making recommendations to enhance eating.
Results: Of thirteen referrals for dysphagia management during 1995, 1I0 charts were available for post-chart review.The mean age of the patients was 44.2 years with a range from
27 to 70 years.The sample consisted of 9 men and I woman, 50% of which were placed
on alternative nutritional support with no oral food permitted, without improvement of
dysphagia status.Twenty percent were placed on specific aspiration diets with improvement
and advancement of diet; and 30% were placed on aspiration diets with regression to alternative nutritional support.
Lessons Learned: A bedside dysphagia evaluation leads to appropriate recommendations
for specific aspiration diets, alternative nutritional support, positioning techniques, and/or
instruction to compensatory strategies. Evaluation and management of dysphagia can
enhance nutrition, prevent aspiration pneumonia, and improve overall quality of life.
Ri Chan, New York Hospital, Center for Special Studies, 525 East 68th Street, NewYork, NY
USA 10021 Tel: [phone] Fax: [phone]
Mo.B.I 165
MEDICATION ADHERENCE TO LONG-TERM THERAPY IN HIV DISEASE
Eldred, Lois I,Wu A, Chaisson RE, Moore RD. Johns Hopkins University School of Medicine,
Baltimore, Maryland, USA
Objective: To determine the extent of adherence to long-term therapy in HIV-infected
patients engaged in medical care.
Methods: Adherence to therapy was determined by interview of a cohort of patients
attending an urban HIV hospital-based clinic. All patients had been prescribed at least six
months of anti-retroviral therapy and/or anti-Pneumocystis norini (PCP) prophylaxis, had at
least one clinic visit in the prior six months, and were enrolled in the Maryland Medical
Assistance program.
Results: One-hundred twenty-eight patients were enrolled in the study; there were no significant differences in adherence by race or gender Among 74 patients prescribed zidovudine, 37.8% (28) reported missing 9 zidovudine capsules in the previous week; 25.7%
(19) reported missing 2 3 days of therapy in the previous 2 weeks. Of 39 patients prescribed zidovudine 200 mg, 3 times/day 46.2% (I 8) reported usually missing one or more
doses per day Fifty-three patients were prescribed daily trimethoprim-sulfamethoxazole for
PCP prophylaxis; 51.8% (22) reported missing 2 tablets in the previous 3 days. Most
patients (98.2%) could identify their primary care providec were comfortable asking their
provider questions about their medication (92.0%), and felt it was easy to access the clinic
for medication refills (96.4%).
Conclusion: Adherence to long-term therapy remains an important issue in HIV-infected
patients with access to medical care and prescription drug coverage.
Lois. Eldred, PA-C, MPH Carnegie 292, 600 N. Wolfe St., Baltimore, Md 21 287-6220 USA
Phone (4 10)955- I756: Fax (41I0)955-0740; Ieldred(.welchlink.welch.jhu.edu

Mo.B.I 166
HOME CARE FOR PERSONS LIVING WITH AIDS:A NURSING CARE PERSPECTIVE
Portillo, Carmen P ri-/er nerW, Dawson C, Henry S. School of Nursing, University of
California, Sain Francisc-o alifornia
Objectives: The three obje'eives of this study were: I) to describe the numbers and types
of patient problems and nursing interventions received by a sample of patients receiving
home care for an AIDS related problem; 2) to compare (after controlling for prognosis rating) differences in numbers of patient problems and nursing interventions between patients
with private insurance and patients with other payors; and 3) to examine the relationship of
prognosis rating, numbers of patient problems and nursing interventions, and insurance status on three and six month mortality
Methods: As part of a longitudinal study examining the quality of nursing care for persons
with AIDS, patient problems and nursing interventions were collected from patient (n =
65) and nurse interviews and from a review of the home care chart. Each problem and
intervention was coded using the Georgetown Home Health Care Classification System.
The effect of prognosis rating, numbers of patient problems, and insurance status on mortality 3 and 6 months after admission to home care was examined using Chi square.
Results: There were significant (p =.0003) differences in 3 month, but not 6 month, mortality by prognostic category: poor (n = 6), 100%: guarded (n = 21), 24%: fair (n = 32), I16%;
and good (n - 4) 50%. There was also a significant (p =.05) difference in mortality at 3
months only by insurance category private- I I1% and other payor = 34%. Coding of problems and interventions is ongoing.
Conclusions: PLWAs receiving nursing care in the home vary across the continuum of
prognoses. Studies are needed that describe patient problems and nursing interventions at
different stages of the continuum and that examine the linkage between insurance status
and types and numbers of nursing interventions.
C.J. Portillo, University of California, San Francisco, School of Nursing. Box 0608,
San Francisco, CA. USA. 94143-0608.Tel: 4 I15 476-1630
email:nursing c/o [email protected]
Mo.B. I 167
INSTITUTIONAL CARE (INPATIENT/ OUTPATIENT/DAY CARE)
Ong, Dorothy*, Iris Verghese*, Dr Leo, Yee Sin*, Teh, Ai Choo,*. *Communicable Disease
Centre, Republic of Singapore*
Objectives: I) To reduce patients' hospitalisation to save cost and patients can return home
to be with family
2) To create an affordable and conducive day treatment centre which is easily accessible.
3) To have a one-stop outpatient facilities.
Issue: Patients' were fearful of the disease and feel insecure staying at home, slightest discomfort, they want to be admitted. Some patients were not able to come daily for treatment without assistance and financial support.
Method: Upon first diagnosed, patients were referred to Infectious Disease physicians.
Counseled by medical social workers and screened by health advisers. Patients were educated on how to cope with the disease, progressive counseling on personal issues and
advise on safer sex. Patient and family members were advised to practice universal precau
tions. Patients were introduced to the support services available and encouraged to read
up on resources to update themselves.Training programmes for support groups and community care providers were conducted to reduce fear and stigma. At the day treatment
centre patients could come back daily for their drug therapy Pentamidine aerosol therapy
or any short procedures.These will help to reduce the cost and they can spend more time
with their families. It is also a gathering centre for people living with AIDS. At the outpatient,
confidentiality is maintained.The experienced nurse continues to give the holistic support.
Results: Datas collected from January to June 1994 showed that most of the 70% of
repeated admissions were due to:
I) Fear of disease progress and death.
2) Worries about the future.
3) Family and friends not supportive.
After initiating the comprehensive programme and follow through there was a reduction of
repeated admissions to 30%.
Conclusion: Patients were knowledgeable and competent in self care.They were able to
provide support for and among themselves.
Dorothy Ong, Block 1 12 Potong Paslr Avenue I #07-644, Singapore 1 12035
Tel: [phone] Fax:: [phone] email: lynnho(@pacific.net.sg
Mo.B. I 168
HIV/AIDS KNOWLEDGE,ATTITUDES AND PRACTICES OF COMMUNITY-BASED
PRIMARY CARE PHYSICIANS AND DENTISTS
Baldwin, Heather D, EI-SadrW. Ellis. C., Francis, C. Division of Infectious Diseases and Dept.
of Medicine, Harlem Hospital and Columbia University New York, N.Y. United States
Objective: Primary care physicians and dentists are likely to play an increasingly prominent
role in the counseling and care of HIVinfected individuals.The role of these clinicians is of
even greater importance in communities with high rates of HIV infection. We conducted an
assessment of HIV/AIDS knowledge and the prevailing HIV/AIDS attitudes and practices
among community-based primary care physicians and dentists in three urban, minority communities with high AIDS case rates in New York City
Methods: A standardized survey was developed. It included general questions as well as targeted specialty-specific questions for internists/family practitioners, pediatricians, gynecologists/obstetricians and dentists. Four hundred community-based primary care physicians
(n=-200) and dentists (n=-200) completed a 20 minute telephone interview. These clinicians
provided care to predominantly African American and Latino patient populations.
Results: Baseline measurements of HIV/AIDS knowledge, attitudes and practices among primary care practitioners will be presented and discussed.
Conclusions: This study will determine what parameters are influencing community-based
HIV/AIDS medical care in three urban, minority communities and assist in the development
of appropriate educational interventions for clinicians practicing in those communities.
Heather D. Baldwin, 506 Lenox Avenue, Room 3114, New York, New York, 10037, USA.
Telephone: 2 I 2-939-2955 Fax: 2 I 2-939-2968 email: [email protected]

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