Table 1.
Demographics, Qualifications and Experience, and Care Delivery Among Human Immunodeficiency Virus (HIV) Care Providers at All HIV Healthcare Facilities and at Ryan White HIV/AIDS Program–Funded Facilities and Private Practices (N = 1234)—Medical Monitoring Project, 2013–2014 Provider Survey
| Characteristic | All Providers (N = 1234)
|
Providers at RWHAP-Fundeda Facilities (n = 723)
|
Providers in Private Practicea (n = 211)
|
Rao-Scott χ2 P Value Comparing Columns B and C | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Column A
|
Column B
|
Column C
|
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| No. | Weighted %b | (95% CI) | No. | Weighted %b,c | (95% CI) | No. | Weighted %b | (95% CI) | ||
| Demographics | ||||||||||
|
| ||||||||||
| Age, y | .44 | |||||||||
| <40 | 211 | 17.5 | (12.9–22.2) | 132 | 19.5 | (14.4–24.5) | 29 | 12.7 | (5.3–20) | |
| 40–49 | 326 | 24.0 | (21.2–26.8) | 192 | 23.9 | (20.3–27.5) | 56 | 25.7 | (17.5–33.9) | |
| 50–59 | 453 | 38.4 | (32.3–44.6) | 284 | 40.6 | (34.6–46.6) | 76 | 41.8 | (30.3–53.3) | |
| ≥60 | 204 | 20.1 | (14.8–25.3) | 96 | 16.0 | (10–21.9) | 42 | 19.9 | (9.6–30.1) | |
|
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| Sex | .006 | |||||||||
| Male | 620 | 56.5 | (49.6–63.5) | 314 | 44.7 | (37.8–51.6) | 143 | 68.2 | (53.4–83) | |
| Female | 585 | 43.5 | (36.5–50.4) | 397 | 55.3 | (48.4–62.2) | 61 | 31.8 | (17–46.6) | |
|
| ||||||||||
| Race/Ethnicity | .80 | |||||||||
| White | 783 | 62.9 | (55.8–70.0) | 438 | 60.7 | (48.2–73.2) | 145 | 61.6 | (50–73.2) | |
| Black/African American | 89 | 10.8d | (3.8–17.7) | 65 | 12.0 | (6.8–17.2) | 10 | 12.4d | (0–27.3) | |
| Hispanic | 158 | 10.7d | (3.5–17.8) | 111 | 12.6d | (0–25.5) | 14 | 7.3d | (1.0–13.6) | |
| Other | 179 | 15.6 | (10.7–20.6) | 102 | 14.7 | (9.3–20.1) | 37 | 18.7 | (10.3–27.1) | |
|
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| Sexual orientation | .67 | |||||||||
| Heterosexual | 980 | 85.1 | (81.0–89.2) | 580 | 83.0 | (78.9–87.1) | 144 | 80.8 | (71.7–89.9) | |
| Gay, lesbian, or bisexual | 211 | 14.9 | (10.8–19.0) | 123 | 17.0 | (12.9–21.1) | 59 | 19.2 | (10.1–28.3) | |
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| Qualifications and experience | ||||||||||
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| ||||||||||
| Certification type | .0002 | |||||||||
| Infectious diseases board-certified physiciane | 564 | 44.5 | (37.3–51.7) | 289 | 33.6 | (24.9–42.3) | 108 | 53.1 | (37.2–69) | |
| Other board-certified physician | 319 | 30.0 | (22.8–37.3) | 173 | 25.7 | (19.9–31.4) | 71 | 34.2 | (19.1–49.2) | |
| Non-board-certified physician | 61 | 4.8 | (2.2–7.4) | 44 | 7.2d | (.7–13.8) | 5 | 1.3d | (0–2.6) | |
| Nurse practitioner | 217 | 15.2 | (10.3–20.1) | 169 | 25.6 | (17.8–33.4) | 11 | 5.5d | (1.7–9.3) | |
| Physician assistant | 63 | 5.4 | (2.6–8.2) | 42 | 7.9d | (2.1–13.7) | 13 | 5.9d | (0–12.5) | |
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| Physician board certification | .06 | |||||||||
| Infectious diseases | 564 | 59.7 | (51.1–68.3) | 289 | 56.7 | (47.3–66) | 108 | 60.9 | (43.7–78) | |
| Internal medicine | 164 | 20.0 | (15.2–24.9) | 88 | 18.8 | (13.3–24.2) | 46 | 27.2 | (13–41.5) | |
| Family medicine | 102 | 17.0 | (11.2–22.7) | 47 | 17.8 | (9.9–25.7) | 19 | 10.2d | (3.1–17.2) | |
| Pediatrics | 33 | 1.6 | (.9–2.3) | 27 | 4.3 | (2.3–6.2) | 1 | 0.3d | (0–1) | |
| Other board certified | 20 | 1.7d | (.5–2.9) | 11 | 2.5d | (.5–4.5) | 5 | 1.4d | (0–3) | |
|
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| HIV specialist (HIVMA criteria or AAHIV-S) | 865 | 57.8 | (51.2–64.4) | 533 | 71.5 | (63.3–79.7) | 125 | 43.2 | (32.3–54) | <.0001 |
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| HIV patients for whom you provide continuous and direct care | .003 | |||||||||
| 0–20 | 103 | 15.1 | (9.5–20.7) | 38 | 8.0 | (4–12.1) | 29 | 19.4d | (5.8–33.1) | |
| 21–50 | 186 | 19.6 | (14.4–24.8) | 98 | 15.5 | (9.7–21.4) | 36 | 26.8 | (12.9–40.6) | |
| 51–200 | 479 | 39.0 | (34.2–43.8) | 289 | 38.4 | (31.4–45.3) | 72 | 38.5 | (22.1–54.8) | |
| ≥200 | 437 | 26.3 | (20.4–32.1) | 281 | 38.0 | (30.1–46) | 67 | 15.3 | (8.1–22.5) | |
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| Years caring for HIV patients | .14 | |||||||||
| 0–10 | 427 | 35.3 | (29.9–40.7) | 267 | 37.6 | (32.3–43) | 59 | 32.1 | (20.1–44.1) | |
| 11–20 | 428 | 36.1 | (32.1–40.0) | 278 | 41.5 | (35.6–47.3) | 62 | 33.6 | (24.5–42.8) | |
| ≥21 | 365 | 28.6 | (24.6–32.6) | 171 | 20.9 | (16.3–25.4) | 86 | 34.3 | (21.4–47.1) | |
|
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| Provides primary caref | 1094 | 83.1 | (78.4–87.8) | 679 | 93.8 | (89.8–97.8) | 163 | 74.4 | (64.4–84.4) | <.0001 |
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| Provides care in language other than English | 519 | 38.7 | (31.3–46.2) | 334 | 47.9 | (37.5–58.4) | 76 | 31.3 | (20.8–41.8) | .009 |
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| Care delivery | ||||||||||
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| Comanagement of patients with other HIV care providers | .02 | |||||||||
| Provides expert assistance to less experienced providers | 527 | 36.9 | (30.5–43.2) | 325 | 44.1 | (36.7–51.5) | 77 | 31.5 | (21–42) | |
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| Receives assistance from HIV experts | 241 | 25.3 | (19.5–31.0) | 156 | 28.9 | (19.7–38.1) | 31 | 21.8d | (8.5–35.1) | .45 |
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| Caseload of 0–20 patients and receives expert assistance | 52 | 52.2 | (38.1–66.4) | 24 | 6.2d | (2.2–10.3) | 12 | 9.2d | (1.5–16.8) | .46 |
| Caseload of 21–50 patients and receives expert assistance | 34 | 19.0d | (7.7–30.3) | 23 | 6.3d | (1.1–11.4) | 6 | 2.3 | (.0–4.7) | .09 |
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| Caseload of >50 patients and receives expert assistance | 149 | 20.6 | (14.6–26.6) | 105 | 16.5 | (11.1–21.8) | 12 | 10.5d | (.0–22.9) | .47 |
|
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| Hours devoted to patient care per week | <.0001 | |||||||||
| 0–19 | 224 | 13.3 | (11.0–15.7) | 150 | 19.2 | (13.4–25) | 16 | 6.5d | (2.3–10.7) | |
| 20–29 | 184 | 12.5 | (9.1–15.8) | 122 | 15.9 | (12.5–19.2) | 14 | 7.7d | (1.2–14.1) | |
| 30–39 | 201 | 11.4 | (7.8–15.1) | 143 | 21.5 | (16.3–26.8) | 14 | 2.7d | (.7–4.8) | |
| ≥40 | 614 | 62.8 | (56.5–69.0) | 304 | 43.4 | (37.3–49.5) | 164 | 83.1 | (75–91.2) | |
|
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| Accepting new patients | 1149 | 93.5 | (90.7–96.4) | 684 | 96.1 | (94.6–97.7) | 191 | 94 | (89.8–98.2) | .28 |
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| No. of patients able to care for in 5 y | .60 | |||||||||
| Fewer or no patients | 146 | 11.5 | (8.0–15.1) | 79 | 11.2 | (7.5–14.9) | 23 | 7.8 | (3.7–12) | |
| Same number of patients | 371 | 29.3 | (24.7–33.9) | 210 | 30.5 | (24.3–36.6) | 68 | 29.9 | (18.6–41.1) | |
| More patients | 708 | 59.1 | (53.0–65.2) | 430 | 58.3 | (52.3–64.4) | 117 | 62.3 | (50.6–74) | |
|
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| Will leave practice within 5 y | 122 | 9.4 | (6.7–12.2) | 65 | 11.1 | (6.3–15.8) | 12 | 3.5 | (.9–6.2) | .0004 |
| Practices at a facility that: | ||||||||||
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| Uses an electronic medical record | 759 | 62.2 | (48.9–75.5) | 456 | 55.0 | (38.3–71.8) | 117 | 63.2 | (42.4–84) | .46 |
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| Utilizes an integrated team | 874 | 54.1 | (45.6–62.6) | 638 | 89.3 | (85.1–93.5) | 37 | 14.9 | (6.7–23.1) | NA |
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| Provides on-site case management | 850 | 50.8 | (41.5–60.1) | 636 | 90.4 | (85.9–94.8) | 41 | 16.0d | (0–34.3) | <.0001 |
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| Provides on-site adherence counseling | 927 | 54.2 | (43.9–64.6) | 670 | 92.1 | (87.5–96.8) | 81 | 29.7 | (20.8–38.5) | NA |
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| Provides on-site mental health services | 799 | 45.1 | (36.8–53.4) | 614 | 80.2 | (75–85.5) | 23 | 5.6d | (0–11.4) | NA |
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| Provides on-site substance abuse treatment | 433 | 23.5 | (17.3–29.6) | 347 | 46.3 | (34–58.6) | 8 | 1.4d | (0–2.9) | <.0001 |
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| >50% of patients are: | ||||||||||
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| Nonwhite | 907 | 62.0 | (48.6–75.4) | 618 | 83.8 | (74.6–93.1) | 92 | 42.6 | (28.6–56.6) | <.0001 |
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| Women | 60 | 6.3 | (2.7–9.8) | 41 | 7.3d | (2.9–11.6) | 5 | 3.6d | (0–8.9) | .36 |
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| Men who have sex with men | 563 | 47.6 | (37.1–58.0) | 268 | 35.5 | (25.9–45.1) | 140 | 55.6 | (40.9–70.4) | .002 |
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| Injecting drug users | 35 | 2.9d | (.0–6.7) | 31 | 7.3d | (0–16.6) | 0 | NA | NA | NA |
Abbreviations: AAHIV-S, American Academy of HIV Medicine Practicing HIV Specialist; CI, confidence interval; HIV, human immunodeficiency virus; HIVMA, HIV Medicine Association; NA, not applicable; RWHAP, Ryan White HIV/AIDS Program.
a
Excludes providers who worked at facilities that were both RWHAP-funded and private practices (n = 61) or neither (n = 132) or for whom RWHAP funding status was not ascertained (n = 107).
b
Values exclude “don’t know” responses.
c
Percentages of providers who worked at facilities that received RWHAP funding among 1127 providers at facilities with known RWHAP funding status.
d
Coefficient of variation is >.30; estimate may be unreliable.
e
Physicians (Doctor of Medicine [MD] and Doctor of Osteopathic Medicine [DO]) who were board certified in infectious diseases and another specialty were classified as infectious diseases physicians.
f
Defined as point of first contact and comprehensive care, with emphasis on prevention and coordination of care.