1525. HIV Specialty Clinics as Primary Care Providers: Relationship to Hypertension Outcomes
Session: Poster Abstract Session: HIV: Clinical Care
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster Final.pdf (1005.1 kB)
  • Background: 

    Care for persons with HIV increasingly focuses on common comorbidities, such as hypertension. Evidence indicates antiretroviral therapy and opportunistic infections are best managed by experienced providers who specialize in HIV medicine, but it is unclear how best to structure care for comorbidities. Approaches include providing care for comorbidities in HIV specialty clinics (“concurrent care”) and arrangements that combine HIV specialty care with management of comorbidities in primary care clinics (“shared care”). We compared rates of blood pressure (BP) control for persons with HIV and hypertension in HIV clinics that practiced concurrent care with rates in HIV clinics that practiced shared care.

    Methods:

    We created a cohort of Veterans with HIV and hypertension receiving care in HIV specialty clinics in Veterans Administration facilities in 2013 and merged these data with results from a survey asking HIV clinic staff how they delivered hypertension care (7,778 Veterans in 73 clinics). BP control was defined as BP < 140/90mmHg on the most recent measure. We used multilevel logistic regression to compare patients’ likelihood of experiencing BP control in clinics offering concurrent vs. shared care, after adjusting for patient characteristics (i.e. age, race, comorbidity, and body mass index).

    Results:

    Clinic staff in 42(57.5%) clinics reported practicing concurrent care for hypertension, while in 31(42.5%) they reported shared care. Concurrent care clinics were larger and more likely to use multidisciplinary teams than shared care clinics. The unadjusted rate of BP control was 65.5% in concurrent care clinics, vs 60.2% in shared-care clinics (P=0.007). The likelihood of BP control remained higher for patients in concurrent care clinics after adjusting for patient characteristics (adjusted odds ratio for BP control in concurrent vs shared-care clinics 1.25(1.02-1.52).

    Conclusion:

    Rates of BP control were higher in HIV specialty clinics that reported managing hypertension themselves, compared to clinics that reported shared-care. For shared care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.

    A Ben Appenheimer, MD1,2, Barbara Bokhour, PhD3,4, Donald Mcinnes, ScD3,4, Kelly Richardson, PhD2, Amanda Midboe, PhD5, Allen Gifford, MD3,4, Steven Asch, MD5, Kelly Dvorin, PsyD3, Andrew Thurman, PhD2, Mary Vaughan-Sarrazin, PhD6 and Michael Ohl, MD, MSPH2,6, (1)University of Iowa Carver College of Medicine, Iowa City, IA, (2)Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, IA, (3)Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MA, (4)Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, (5)Center for Innovation to Implementation, VA Palo Alto Medical Care System, Menlo Park, CA, (6)Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA

    Disclosures:

    A. B. Appenheimer, None

    B. Bokhour, None

    D. Mcinnes, None

    K. Richardson, None

    A. Midboe, None

    A. Gifford, None

    S. Asch, None

    K. Dvorin, None

    A. Thurman, None

    M. Vaughan-Sarrazin, None

    M. Ohl, None

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