11th International AIDS Conference Vancouver, British Columbia — July 7-12, 1996

Int Conf AIDS 1996 Jul 7-12; 11:30 (abstract no. LB.B.6042)
Smith R, Putnam ST, Luce C, Perkins P, Anderson K; AIDS Consultation Service, Maine Medical Center, Portland, ME. Fax: (207) 871-6116. E-mail: smithr.data@office.mmc.org.

ISSUE: In the second decade of the AIDS epidemic, an increasing proportion of cases are reported from rural areas. In Maine, the percentage of AIDS cases reported from non-metropolitan areas increased from 30% to 58% between 1986 to 1994. Provision of state-of-the-art care for persons with HIV living in rural areas is complicated by geographic isolation of patients from large clinics or medical centers, lack of experience with HIV care by primary care givers, and decreased access to social support services.

PROJECT: A multidisciplinary consultation and outreach service was developed in 1992 at Maine Medical Center to support primary care providers in the delivery of HIV care throughout Maine. The service included a consultation clinic staffed by a nurse, nutritionist, social worker, and an infectious disease specialist; an outreach educational program directed at primary care providers; and a quarterly newsletter with clinical care updates. The service was supported by hospital funds, patients care revenue, private foundations grants, and revenues from pharmaceutical company sponsored clinical trials.

RESULTS: During its first 3 years of operation, the AIDS Consultation Service at Maine Medical Center provided specialty support to 160 patients referred by 106 physicians. 70 patients from areas outside of Cumberland County were referred by 52 physicians representing 32 towns and 8 counties. 57% of these patients were from areas designated as non-metropolitan by the U.S. Census Bureau. Comparison between metropolitan Cumberland County and non-metropolitan referrals revealed increased frequency of AIDS diagnosis at referral (46% vs. 62%) for rural cases and a similar mean number of visits (4.2 vs. 4.1). Fifty patients (including 24 not seen in consultation) were enrolled in community based or pharmaceutical clinical trials, 28% of whom were from outside of Cumberland County. Two surveys of provider and patient satisfaction were conducted and demonstrated a high level of satisfaction with the consultation service.

LESSONS LEARNED: A hospital based HIV consultation service can effectively support the primary care management of HIV disease over a large geographic area. Success can be enhanced by: 1) a multidisciplinary team approach; 2) ongoing educational efforts to support primary care providers; 3) efficient and regular communication between primary care providers and the specialty service.

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LBB6042

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