Aids specialist versus generalist ambulatory care for advanced hiv infection and impact on hospital use

Barbara J. Turner, Linda McKee, Thomas Fanning, Leona E. Markson

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


We examined patterns of ambulatory care in the year before diagnosis of acquired immune deficiency syndrome (AIDS) for 5,720 persons infected with human immunodeficiency virus (HIV) who were continuously enrolled in the New York State Medicaid program and diagnosed in 1984-90. For 3,175 persons followed > 6 months after AIDS, we also examined the change between the year before AIDS diagnosis and the 6 months afterward in the pre-dominant provider who was seen most frequently and at least twice. Approximately 75% of the population had a predominant provider identified. Of this group, 43% of the patients had a generalist as their predominant provider before AIDS diagnosis, falling to only 25% after diagnosis. The pro-portion with an AIDS specialist predominant provider increased from 22% before AIDS diagnosis to 39% afterward (P < 0.001). Patients with a generalist predominant provider before AIDS diagnosis had higher odds of switching providers and of hospitalization after AIDS diagnosis than patients with an AIDS specialist predominant provider. If generalists are to be encouraged to manage patients with advanced HIV disease, a better understanding of factors contributing to these outcomes is needed.

Original languageEnglish (US)
Pages (from-to)902-916
Number of pages15
JournalMedical Care
Issue number9
StatePublished - Sep 1994
Externally publishedYes


  • Acquired immunodeficiency syndrome
  • Ambulatory care
  • Hospitalization
  • Medical assistance
  • Primary health care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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