Developing care in the community: GPs and the HIV epidemic

Abstract

Services for HIV infection and AIDS in Parkside DHA have been largely hospital based with little active involvement of local GPs. In response to the wishes of those with HIV/AIDS and predicted increases in the number of patients the DHA is now developing an AIDS strategy which identifies the development of primary and community care as a major objective. A postal survey of all 263 GPs within the DHA was undertaken in order to ascertain their views about the role of primary care in the management of HIV infection/AIDS. Replies were received from 75% (196). The responses to the survey indicated both the potential of general practice and willingness of GPs to be involved in the care of this client group. However, two key issues in developing this strategy were identified. These were information exchange and confidentiality. It is suggested that both hospitals and general practice must develop rigorous confidentiality policies to overcome these difficulties.

Community-based health services for people with HIV/AIDS: A review from a health service perspective

“…Freeling, 1988); this has clear implications both for taking an accurate case history and giving advice within the consultation. GPs are also unwilling to treat drug misusers (Bell et al, 1990;King, 1989;McKeganey & Boddy, 1988;Roderick et al, 1990).…”

“…Patients' fears that doctors will not respect their desire for complete confidentiality may be well founded: studies consistently report that GPs think they should be told the HIV status of their patients, irrespective of whether specific consent has been given (Naji et al, 1989;Roderick et al, 1990;Sibbald & Freeling, 1988). King (1989) found in his study that 20% of doctors with HIV positive patients tagged their notes in some way, usually with a warning flag or notice inside the envelope.…”

“…One of the most effective methods of training appears to be by experience. Participation in shared clinic or hospital sessions increases GP's confidence and skills and has a positive effect on attitudes to people with HIVIAIDS (Roderick et al, 1990). Shared care models also facilitate communication between the hospital and the GP, although there may be implications for maintaining confidentiality.…”

“…Duplication of services-for example, a specialist nursing team working alongside district nurses-may lead to confusion amongst service providers and users (Cunningham, 1989b). Lines of responsibility of patient management can become blurred; the St Mary's Home Support Team has acknowledged that this led to ambiguity of responsibility to patients from both within and outside the health district (Roderick & Stevens, 1989). In addition, initially there was little co-ordination between the Team and generic services either at the planning or delivery stage.…”

“…(b) Although most people with AIDS are registered with a GP (Roderick et al, 1990), a significant minority are not (Mansfield & Singh, 1989). This may be due to a chaotic lifestyle-for example, the homeless are unlikely to have a GP-or because they have been taken off a list.…”