Teleconsultation improves primary care clinicians' confidence about caring for HIV

Area of Science:

• Medical Informatics
• Public Health
• Infectious Disease Management

Background:

• Telemedicine facilitates communication between primary care clinicians and specialists, potentially enabling independent practice and reducing referrals.
• A federally funded HIV teleconsultation service (HIV Warmline) provides live telephone access to HIV specialists for US clinicians.
• The impact of the HIV Warmline on clinician competence and referral rates was previously unstudied.

Purpose of the Study:

• To assess if primary care clinicians using the HIV Warmline felt more capable of managing human immunodeficiency virus (HIV) in their practices.
• To evaluate the effect of teleconsultation on primary care clinicians' confidence and referral patterns for HIV management.

Main Methods:

• An online survey was administered to primary care physicians and mid-level practitioners who utilized the HIV Warmline for teleconsultation between January 2008 and March 2010.
• Participants compared the HIV Warmline to alternative methods for obtaining HIV clinical support.
• The survey rated the impact of the HIV Warmline on participants' confidence in managing HIV and their patient referral practices.

Main Results:

• 191 respondents (59% response rate) found the HIV Warmline quicker, more applicable, and more trustworthy than other HIV information sources.
• Following use of the HIV Warmline, 90% reported improved confidence in HIV care, 67% noted a change in their management approach, and 74% avoided specialist referrals.
• The availability of live, free consultation was highly valued by all participants.

Conclusions:

• Primary care clinicians reported enhanced confidence in HIV care and a decreased need for specialist referrals after using the HIV Warmline.
• Teleconsultation appears to be an effective tool for consolidating HIV care within primary care settings.
• The teleconsultation model could be adapted for managing other medical conditions, though its impact on referral rates, quality of care, and clinical outcomes requires further investigation.