Primary care providers who provide clinical HIV care (HIV PCPs) are experiencing rising HIV caseloads from newly insured patients under the Patient Protection and Affordable Care Act (PPACA), according to a national survey released today by HealthHIV. Forty percent of those surveyed say that the number of providers treating HIV in their area is inadequate for the demand. Half of HIV PCPs say their HIV caseloads have grown, a trend likely to continue as health reform steers patients to primary care settings.
HealthHIV's Third Annual State of HIV Primary Care National Survey report provides a profile of an HIV PCP. The profile shows that a majority of HIV PCPs are female, 54 percent are physicians, and 55 percent are over the age of 50. They primarily work in urban or metropolitan areas and are more likely to treat underserved populations, including racial and ethnic minorities, homeless, and immigrant populations.
"Considering these findings, we compared the PPACA enrollment numbers with the number of PCPs added and needed to treat the newly insured," said HealthHIV Executive Director Brian Hujdich. "This comparison shows that, as the demand for health care increases through enrollment in health care plans, the workforce supply continues to decrease, creating a shortfall of 8,000 PCPs to treat the newly insured." The gap is illustrated in a thermometer graphic, which documents the shortfall as of April 29, 2014.
Nearly half (49 percent) of PCPs surveyed do not provide clinical HIV care; they cite a lack of knowledge about HIV treatment as a significant barrier to providing care. A similar number (48 percent) say they need more clinical training to fully integrate HIV care into their practice.
The need for training to increase the capacity of primary health care teams to deliver quality, coordinated, and efficient care was identified by the Health Resources and Services Administration in an April 9 U.S. Senate committee hearing on primary care access and workforce challenges. The hearing revealed that nearly one in five Americans live in areas where there is a shortage of primary care providers and by 2025 we will need over 50,000 new primary care physicians nationally. Only seven percent of the nation's medical school graduates currently choose a primary care career, so new incentives and training programs are needed to fill the gap.
Addressing this need, HealthHIV provides an HIV Primary Care Training and Certificate Program for health care providers, which can improve their clinical and professional knowledge, skills and competencies, and provide quality care to patients with HIV.
In addition to growing caseloads, providers are treating HIV patients with more complex co-occurring conditions. According to the survey, obesity, syphilis, cardiovascular disease, depression, and renal disease are the top five conditions PCPs see increasingly in patients with HIV.
The survey also found that HIV specialists continue to expand their practice to include overall primary care. Eighty-seven percent of respondents who identified as HIV specialists work in primary care, highlighting an opportunity to leverage their expertise to mentor PCPs in HIV treatment. The survey suggests that training and mentoring programs would help reduce significant treatment gaps identified in the survey, including:
- Routine HIV testing;
- Implementation of pre-exposure prophylaxis (PrEP); and
- Management of hepatitis C (HCV) co-infection.
Eighty-nine percent of HIV PCPs test patients for HCV, but far fewer actively manage co-infection (59 percent). More than a quarter of HIV PCPs saw an increase in the number of patients with HCV co-infection and 40 percent said managing this co-infection is their greatest educational need.
Other major barriers to quality care identified by HIV PCPs include retaining patients in care and providing substance abuse and mental health support, which are the most referred services. Building strong patient-provider relationships and helping patients access support services were recommended strategies by those surveyed for retaining patients in care. "As health reform is implemented, providers must be educated on addressing these challenges and keeping 'Patient Protection' in the PPACA," Hujdich said.
Providers also need more thorough training on health care reform, especially changes to service delivery and reimbursement. Six in ten HIV PCPs surveyed currently rely on funding from the Ryan White HIV/AIDS Program and the AIDS Drugs Assistance Programs (ADAP); however, only 27 percent are ready to retool their infrastructure to transition patients to Medicaid and private health insurance.
"In evaluating the survey's findings, we developed a five-point Roadmap to HIV Primary Care Integration," Hujdich said. "The roadmap points are to recruit HIV workforce; educate PCPs on HIV; treat the whole patient; collaborate with colleagues and consumers; and act on the PPACA."
HealthHIV conducted the Third Annual State of HIV Primary Care National Survey in partnership with Medscape, LLC, to assess the current state of integrating HIV care and treatment services into primary care. The survey provides insight on the rapidly changing landscape of HIV care in the United States. The full report and associated infographics are available online at www.healthhiv.org.
HealthHIV and Medscape, LLC conducted a 56-question online survey of 2,531 medical doctors, physician's assistants, registered nurses, pharmacists, dentists, researchers, health administrators, social workers, case managers, and consumers. Analysis focuses on 371 providers who work within the scope of primary care as defined by the American Academy of Family Physicians.