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Teleconsultation Improves Primary Care Clinicians’ Confidence about Caring for HIV

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Abstract

BACKGROUND

Telemedicine can facilitate communication between primary care clinicians and specialists. Generalists who use telemedicine for consultation (teleconsultation) may be able to practice more independently and reduce the number of formal referrals to specialists. In the United States, a federally funded human immunodeficiency virus (HIV) teleconsultation service (HIV Warmline) offers clinicians live telephone access to HIV specialists; however, its impact on clinicians’ self-perceived clinical competence and referral rates has not been studied.

OBJECTIVE

To determine if primary care clinicians who used the HIV Warmline felt more capable of managing HIV in their own practices.

DESIGN

Online survey.

PARTICIPANTS

Primary care physicians and mid-level practitioners who used the HIV Warmline for teleconsultation between 1/2008 and 3/2010.

MAIN MEASURES

Participants compared the HIV Warmline to other methods of obtaining HIV clinical support, and then rated its impact on their confidence in their HIV skills and their referral patterns.

KEY RESULTS

Respondents (N = 191, 59 % response rate) found the HIV Warmline to be quicker (65 %), more applicable (70 %), and more trustworthy (57 %) than other sources of HIV information. After using the HIV Warmline, 90 % had improved confidence about caring for HIV, 67 % stated it changed the way they managed HIV, and 74 % were able to avoid referring patients to specialists. All valued the availability of live, free consultation.

CONCLUSIONS

Primary care clinicians who called the HIV Warmline reported increased confidence in their HIV care and less need to refer patients to specialists. Teleconsultation may be a powerful tool to help consolidate HIV care in the primary care setting, and could be adapted for use with a variety of other medical conditions. The direct impact of teleconsultation on actual referral rates, quality of care and clinical outcomes needs to be studied.

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Abbreviations

HIV:

Human immunodeficiency virus

AIDS:

Acquired immunodeficiency syndrome

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Acknowledgements

Contributors

No additional contributors.

Funders

The National HIV/AIDS Clinicians’ Consultation Center administers the HIV Warmline at the University of California San Francisco and is supported by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau’s AIDS Education and Training Centers (AETCs) (Grant No. H4AHA01082).

Dr. Waldura is supported in part by a National Institutes of Health Award Number KL2RR024130 from the National Center for Research Resources.

Dr. Dehlendorf is supported by Grant Number K23HD067197 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health.

Prior Presentations

A preliminary version of our findings was presented as a poster at 2010 Ryan White Grantee Meeting and 13th Annual Clinical Conference in Washington D.C., August 2010.

Conflict of Interest

Drs. Waldura and Goldschmidt and Ms. Neff receive salary support from the National HIV/AIDS Clinicians’ Consultation Center, which administers the HIV Warmline as a grant-support project of the Department of Family and Community Medicine at the University of California, San Francisco.

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Authors and Affiliations

  1. Department of Family and Community Medicine, San Francisco General Hospital, University of California, San Francisco, USA

    Jessica F. Waldura MD MAS, Sarah Neff MPH, Christine Dehlendorf MD MAS & Ronald H. Goldschmidt MD

Authors
  1. Jessica F. Waldura MD MAS
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  2. Sarah Neff MPH
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  3. Christine Dehlendorf MD MAS
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  4. Ronald H. Goldschmidt MD
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Corresponding author

Correspondence to Jessica F. Waldura MD MAS.

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Waldura, J.F., Neff, S., Dehlendorf, C. et al. Teleconsultation Improves Primary Care Clinicians’ Confidence about Caring for HIV. J GEN INTERN MED 28, 793–800 (2013). https://doi.org/10.1007/s11606-013-2332-5

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