2.50
Hdl Handle:
http://hdl.handle.net/10755/158200
Type:
Presentation
Title:
HIV Prevention: Do Physicians and Nurse Practitioners Provide Equivalent Care?
Abstract:
HIV Prevention: Do Physicians and Nurse Practitioners Provide Equivalent Care?
Conference Sponsor:Western Institute of Nursing
Conference Year:1995
Author:Carney, Patricia, PhD
P.I. Institution Name:Dartmouth Medical School Dept of Community & Family Medicine
Title:Research Assistant Professor
Contact Address:, Hanover, NH, USA
Contact Telephone:
HIV now affects more than 2 million people in the United States.

It is currently a leading cause of death in men and women between

the ages of 30 and 44. With budget cuts in State and federal

funding for HIV testing and education, patients will logically turn

to their primary care providers for these services. Studies

indicate that HIV preventive services are not provided in primary

care practice at an acceptable rate, though the specific gaps in

performance are unclear. This study used an unannounced

standardized patient (lay individuals trained to replicate a

clinical encounter consistently) methodology to evaluate HIV

preventive performance in 22 family nurse practitioners and family

physicians. Five standardized patients (SPs) were carefully

trained to present an identical patient scenario and were tested

prior to making study visits. Each provider was visited once

during the study period. None of the SPs were detected as being

from the Project. Audio taping via a hidden microphone and

recorder was used to validate the reproducibility of clinical

encounters and accuracy of standardized patient assessment. The

providers in this study were similar in demographic

characteristics, such as age, number of years in clinical practice

and number of years at current practice location. However, they

differed in practice characteristics, such as the population served

(FNPs provided more preschool-aged care, while physicans provided

more older and elder adult care) and type of care provided (FNPs

reported providing more acute care, while physicians reported

providing more chronic care). Inter-observer techniques using the

Kappa Coefficient revealed the standardized patients were highly

accurate in both case portrayal and assessment activities. Results

from the study visits indicate that even when prompted by the

patient with a concern about AIDS, most study variables were

performed between 9 and 60% of the time. No providers assessed

sexual practices and none followed the U.S. Preventive Services

Task Force Guidelines on HIV preventive educational practices. In

general, both types of providers performed higher in providing

education about HIV testing than in assessing risk and providing

educational content about risk factor reduction. Family nurse

practitioners assessed condom use, past surgical history, past

history of STDs, and past history of blood transfusions more often

than physicians, while physicians assessed number of past sexual

partners, IV drug use and past HIV testing more often than nurse

practitioners. Regarding the provision of Educational content,

family nurse practitioners performed at higher rates in four of the

six study variables, including HIV being transmitted through

unprotected sex, and latex versus natural membrane condom use.

FNPs performed at higher rates for 3 of the 6 study variables on

HIV testing, such as explaining that HIV testing is available,

anonymity of testing, and providing written material and in 4 of

the 5 variables on risk reduction recommendations, such as

receiving testing, limiting the number of sexual partners, using a

condom and discussing risk of exposure with partner. No

differences were identified in how time was spent and the cost of

visit by type of provider. The methodology used in this study was

highly innovative, identifying implications for health care

providers, educators, researchers and health policy makers.

Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleHIV Prevention: Do Physicians and Nurse Practitioners Provide Equivalent Care?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/158200-
dc.description.abstract<table><tr><td colspan="2" class="item-title">HIV Prevention: Do Physicians and Nurse Practitioners Provide Equivalent Care?</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1995</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Carney, Patricia, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Dartmouth Medical School Dept of Community &amp; Family Medicine</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, Hanover, NH, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value"> </td></tr><tr class="item-email"><td class="label">Email:</td><td class="value"> </td></tr><tr><td colspan="2" class="item-abstract">HIV now affects more than 2 million people in the United States.<br/><br/>It is currently a leading cause of death in men and women between<br/><br/>the ages of 30 and 44. With budget cuts in State and federal<br/><br/>funding for HIV testing and education, patients will logically turn<br/><br/>to their primary care providers for these services. Studies<br/><br/>indicate that HIV preventive services are not provided in primary<br/><br/>care practice at an acceptable rate, though the specific gaps in<br/><br/>performance are unclear. This study used an unannounced<br/><br/>standardized patient (lay individuals trained to replicate a<br/><br/>clinical encounter consistently) methodology to evaluate HIV<br/><br/>preventive performance in 22 family nurse practitioners and family<br/><br/>physicians. Five standardized patients (SPs) were carefully<br/><br/>trained to present an identical patient scenario and were tested<br/><br/>prior to making study visits. Each provider was visited once<br/><br/>during the study period. None of the SPs were detected as being<br/><br/>from the Project. Audio taping via a hidden microphone and<br/><br/>recorder was used to validate the reproducibility of clinical<br/><br/>encounters and accuracy of standardized patient assessment. The<br/><br/>providers in this study were similar in demographic<br/><br/>characteristics, such as age, number of years in clinical practice<br/><br/>and number of years at current practice location. However, they<br/><br/>differed in practice characteristics, such as the population served<br/><br/>(FNPs provided more preschool-aged care, while physicans provided<br/><br/>more older and elder adult care) and type of care provided (FNPs<br/><br/>reported providing more acute care, while physicians reported<br/><br/>providing more chronic care). Inter-observer techniques using the<br/><br/>Kappa Coefficient revealed the standardized patients were highly<br/><br/>accurate in both case portrayal and assessment activities. Results<br/><br/>from the study visits indicate that even when prompted by the<br/><br/>patient with a concern about AIDS, most study variables were<br/><br/>performed between 9 and 60% of the time. No providers assessed<br/><br/>sexual practices and none followed the U.S. Preventive Services<br/><br/>Task Force Guidelines on HIV preventive educational practices. In<br/><br/>general, both types of providers performed higher in providing<br/><br/>education about HIV testing than in assessing risk and providing<br/><br/>educational content about risk factor reduction. Family nurse<br/><br/>practitioners assessed condom use, past surgical history, past<br/><br/>history of STDs, and past history of blood transfusions more often<br/><br/>than physicians, while physicians assessed number of past sexual<br/><br/>partners, IV drug use and past HIV testing more often than nurse<br/><br/>practitioners. Regarding the provision of Educational content,<br/><br/>family nurse practitioners performed at higher rates in four of the<br/><br/>six study variables, including HIV being transmitted through<br/><br/>unprotected sex, and latex versus natural membrane condom use.<br/><br/>FNPs performed at higher rates for 3 of the 6 study variables on<br/><br/>HIV testing, such as explaining that HIV testing is available,<br/><br/>anonymity of testing, and providing written material and in 4 of<br/><br/>the 5 variables on risk reduction recommendations, such as<br/><br/>receiving testing, limiting the number of sexual partners, using a<br/><br/>condom and discussing risk of exposure with partner. No<br/><br/>differences were identified in how time was spent and the cost of<br/><br/>visit by type of provider. The methodology used in this study was<br/><br/>highly innovative, identifying implications for health care<br/><br/>providers, educators, researchers and health policy makers.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T20:36:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:36:34Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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