Primary care consultations and costs among HIV-positive individuals in UK primary care 1995–2005: a cohort study
- H E R Evans1,
- A Tsourapas2,
- C H Mercer1,
- G Rait3,
- S Bryan2,
- M Hamill4,
- V Delpech5,
- G Hughes5,
- G Brook6,
- T Williams7,
- A M Johnson8,
- S Singh3,
- I Petersen3,
- T Chadborn5,
- J A Cassell9
- 1Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UK
- 2Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK
- 3Research Department of Primary Care and Population Health, University College London, London, UK
- 4Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
- 5Centre for Infections, Health Protection Agency, London, UK
- 6Patrick Clements Clinic, North West London Hospitals NHS Trust, London, UK
- 7GPRD, Medicines and Healthcare Regulatory Agency, London, UK
- 8Research Department of Infection and Population Health, University College London, London, UK
- 9Brighton and Sussex Medical School, Falmer, Brighton, UK
- Correspondence to Dr C Mercer, Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK; cmercer{at}gum.ucl.ac.uk
- Accepted 24 September 2009
- Published Online First 22 October 2009
Abstract
Objectives: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence.
Methods: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record.
Results: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications.
Conclusion: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways.
Footnotes
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‣ Additional supplemental tables 1 and 2 are published online only at http://sti.bmj.com/content/vol85/issue7
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Funding This work was funded by the Medical Research Council (MRC), with funding allocated from the Health Departments, under the aegis of the MRC/UK Health Departments Sexual Health and HIV Research Strategy Committee. The MRC has had no role in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper publication. The views expressed are those of the authors and not necessarily those of the MRC or the Health Departments.
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Competing interests None.
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Ethics approval No study-specific ethical approval was required. The protocol was submitted to the Independent Scientific Advisory Committee of the General Practice Research Database, who approved it under delegated authority.
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Contributors: The guarantor was JAC.
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Provenance and Peer review Not commissioned; externally peer reviewed.
