AEGiS-11IAC: An evaluation of shared care of HIV-infected patients with cytomegalovirus retinitis.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

An evaluation of shared care of HIV-infected patients with cytomegalovirus retinitis.

Int Conf AIDS 1996 Jul 7-12; 11:18 (abstract no. We.B.170)
French P, Steel S, Shepherd D; The Mortimer Market Centre, London, UK. Fax: 0171 380 9949.

OBJECTIVE: To evaluate the shared care of patients with cytomegalovirus (CMV) retinitis attending a UK HIV centre.

METHODS: All 41 patients who were diagnosed with CMV during the study period (November 1993 - March 1995) were enroled into a programme of shared care with their local general practitioner (GP). Of these, 29 established care at the Outpatient Department (OPD). Data was collected from the shared care cards and from the following case files: inpatient; OPD; ophthalmology; GP. For each patient the frequency and content of letters between services was assessed. The acceptability of this model of care was evaluated by patient and health care worker questionnaires.

RESULTS: Inpatients: Of 165 CMV related admissions, 107 (65%) were followed up by a discharge summary to a GP. Letter content: 81% had CMV drug name but only 76% its dosage. OPD: Of 122 visits only 48 (39%) were followed by a letter to a GP. Of the 29 GPs whose patients received OPD care, 19 received no correspondence after any attendances. Content: 51 therapy changes were made in the OPD, 44 (86%) were communicated to the GP. Ophthalmology: Of 337 visits, 133 (39%) were followed in letters to GPs. Content: 97% had full details of follow-up, CMV disease activity and medication. Satisfaction: Of the 41 GPs, 28 (68%) responded to the questionnaire. At the onset of the programme 16 out of 28 (57%) felt confident/very confident of taking on shared care compared with 21 out of 28 (75%) once it was established. Patients: A subgroup of patients (n=7) were offered a questionnaire all of whom completed it. All felt either satisfied/very satisfied with shared care although 3 out of the 7 wanted more information on its mechanics.

CONCLUSIONS: Late stage HIV infection is a complex multisystem disease which can only be effectively managed if all the multidisciplinary care team are appropriately used. Both patients and clinicians believed shared care was acceptable but there were problems related to poor communication. This work has prompted the development of clear communication guidelines between primary and secondary care for all patients with HIV infection against which current practices are regularly audited.

Keywords: AEGIS, Cytomegalovirus Retinitis, Evaluation Studies, Physicians, Family, HIV Infections, Cooperative Behavior, Communication, Social Behavior, Questionnaires, Correspondence, Human, nursing, ICA11

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