The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72196

Kevin C. Heslin, PhD, Research Centers in Minority Institutions, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA 90059, 310-869-5056, kheslin@ucla.edu, Ronald M. Andersen, PhD, Department of Health Services, UCLA, 10833 Le Conte Avenue, Room 31-254A CHS, Los Angeles, CA 90024-1006, Susan L. Ettner, PhD, Department of General Internal Medicine and Health Services Research, The David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90024, and William E. Cunningham, MD, MPH, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095.

Previous research has identified infectious diseases training and high patient volume as important aspects of expertise in treating patients with human immunodeficiency virus (HIV). This study addresses the extent to which the benefit of having a physician with HIV-related expertise is realized for all HIV patients in the U.S. Using nationally representative data on 2,864 HIV patients, we estimate the adjusted association of patient race/ethnicity with the use of physicians who have infectious diseases training or high HIV patient volume. In multivariate analyses, African Americans had two-thirds the probability of seeing an infectious diseases specialist (RR = 0.66; 95% CI = 0.56, 0.81) and half the probability of seeing a high-volume physician (RR = 0.47; 95% CI = 0.37, 0.68) as a regular source of care, compared with whites. Analyzing the HIV volume variable in continuous form showed that the physicians seen by African Americans had, on average, 55 fewer HIV patients than did the physicians seen by whites (predictive margin = -55; 95% CI = -92, -6). African Americans are less likely than whites to have physicians with HIV-related expertise, as defined by patient volume and specialization. Racial/ethnic disparities in access to HIV care continue despite government efforts to ameliorate them. Currently, federal programs assisting primary care physicians with repayment of educational loans in exchange for service in health professional shortage areas are not extended to specialists. Making this support more available might encourage physicians with HIV-related expertise to practice in minority communities with high rates of HIV infection.

Learning Objectives:

• At the conclusion of the session, participants will understand the extent of racial/ethnic disparities in access to HIV specialists in the U.S.

Keywords: Access, Physicians

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.