Effects of increasing outpatient diagnosis on AIDS surveillance

Article Abstract:

Changes in surveillance methods may be needed to ensure the accuracy of AIDS reporting as more and more AIDS cases are diagnosed on an outpatient basis. Of 2,552 AIDS cases diagnosed in Washington and Oregon, the proportion diagnosed as outpatients increased from 24% in 1987 to 51% in 1990. This increase is mostly the result of more homosexual or bisexual men being diagnosed in outpatient settings. Also, patients with the AIDS-related conditions of Kaposi's sarcoma, wasting syndrome and esophageal candidiasis were more likely than patients with Pneumocystis carinii pneumonia to be diagnosed as outpatients. Reports to health authorities for outpatient AIDS cases were more often delayed and incomplete, and the conventional surveillance methods of hospital-based surveillance and death-certificate review are not effective for outpatient settings. More direct interaction with physicians and community clinics and the use of indirect sources such as insurance records may improve reporting of outpatient diagnoses.

Hospitals, AIDS (Disease), Disease reporting, Hospital outpatient services

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Developing quality primary care services in HIV/AIDS care: the educational imperative

Article Abstract:

The New South Wales (NSW) Department of Health has developed a program to meet the need for HIV health and social services outside of metropolitan areas. In mid-1990, the anti-HIV drug zidovudine was only available at seven teaching hospitals in two major cities. However, a growing number of HIV patients, especially in the later stages of infection, are moving to rural areas. The project 'A Short Course in HIV Medicine' was developed to increase patients' access to zidovudine and ensure competent care for HIV patients throughout NSW. To be eligible to prescribe zidovudine, local doctors must complete the course, interview and examine a patient, write a comprehensive patient case history and agree to participate in continuing HIV education programs. A secondary goal of the project is to form a network for communicating information and developments in HIV care among hospitals in all of NSW.

Family medicine, HIV infection, HIV infections, Study and teaching, Medicine, Rural, Rural medicine

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