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Primary care consultations and costs among HIV positive individuals in UK primary care 1995-2005: a cohort study.
  1. Hannah E R Evans1,
  2. Angelos Tsourapas2,
  3. Catherine H Mercer3,*,
  4. Greta Rait1,
  5. Stirling Bryan4,
  6. Matthew Hamill5,
  7. Valerie Delpech6,
  8. Gwenda Hughes6,
  9. Gary Brook7,
  10. Tim Williams8,
  11. Anne M Johnson9,
  12. Surinder Singh9,
  13. Irene Petersen10,
  14. Tim Chadborn11,
  15. Jackie A Cassell12
  1. 1 University College London, United Kingdom;
  2. 2 Health Economics Unit, University of Birmingham, United Kingdom;
  3. 3 Centre for Sexual Health and HIV Research, University College London, United Kingdom;
  4. 4 University of Birmingham, United Kingdom;
  5. 5 University of Oxford, United Kingdom;
  6. 6 Health Protection Agency, United Kingdom;
  7. 7 Central Middlesex Hospital, United Kingdom;
  8. 8 GPRD, Medicines and Healthcare Regulatory Agency, United Kingdom;
  9. 9 Research Department of Infection & Population Health, University College London, United Kingdom;
  10. 10 Research Department of Primary Care & population Health, University College London, United Kingdom;
  11. 11 Centrre for Infections, Health Protection Agency, United Kingdom;
  12. 12 Brighton and Sussex Medical School, United Kingdom
  1. Correspondence to: Catherine H Mercer, Centre for Sexual Health & HIV Research, University College London, Centre for Sexual Health & HIV Research, 3rd Floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, United Kingdom; cmercer{at}gum.ucl.ac.uk

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 1995-2005, using data from general practices contributing data to the United Kingdom General Practice Research Database (GPRD). We analysed patterns of consultation and morbidity, and associated consultation costs, among all practice-registered patients for whom HIV positive status was recorded in the general practice record.

Results: 348 practices yielded 5,504 person years (py) of follow up for known HIV positive patients, who consult in GP general practice frequently (4.3 consultations/py, 5.2 consultations/py females in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.2 and 7.4 consultations/py in 1995 in males and females, respectively, converging to rates similar to the wider population. Costs of consultation (GP & nurse, combined) reflecting these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately 1 in 6 medications prescribed in primary care for HIV positive individuals has the potential for major interaction with antiretroviral medications.

Conclusion: HIV positive individuals known to the GP 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.

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