Implications of Generalists' Slow Adoption of Zidovudine in Clinical Practice

doi:10.1001/archinte.1994.00420130091012

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Vol. 154 No. 13, 11 July 1994

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Implications of Generalists' Slow Adoption of Zidovudine in Clinical Practice

Leona E. Markson, ScD; Leon E. Cosler, PhD, RPh; Barbara J. Turner, MD, MSEd

Arch Intern Med. 1994;154(13):1497-1504.

Abstract

Background
The lag time for adoption of new acquired immunodeficiency syndrome(AIDS) therapies into the clinical practices of different typesof ambulatory care providers can be estimated from patient useof zidovudine therapy during the first few years after approvalby the Food and Drug Administration.

Methods
We analyzed receipt of zidovudine therapy from April 1987 throughMarch 1990 by 3643 patients with a diagnosis of AIDS. The studygroup was continuously enrolled in the New York State Medicaidprogram for at least 6 months after diagnosis. For each patient,the dominant providers of ambulatory care, receipt of zidovudinetherapy, and consultation with a human immunodeficiency virus—AIDSspecialist within 6 months after diagnosis were determined fromMedicaid claims. AIDS specialists included physicians or clinicsspecializing in infectious disease or hematology/oncology orspecific clinics within designated AIDS centers.

Results
In 1987, 55% of those who had an AIDS specialist as their dominantcare provider received zidovudine therapy, compared with only36% of patients with a primary care clinic as their dominantcare provider. It was not until 1990, 3 years after approvalby the Food and Drug Administration, that the percentage ofpatients receiving zidovudine therapy (77% to 78%) was comparablefor patients of primary care clinics and AIDS specialists. Inlogistic regression analysis, zidovudine use did not differbetween patients of AIDS specialists and patients with othertypes of dominant providers when the latter group had consultedwith an AIDS specialist (adjusted odds ratio, 1.38; 95% confidenceinterval, 0.99 to 1.95).

Conclusions
In our AIDS study population, there was at least a 3-year lagbefore patients of primary care clinics received zidovudinetherapy at the same rate as patients of AIDS specialists. Conditionssuch as AIDS with rapid changes in treatment options may requirea close relationship between generalists and specialists toincrease access to new therapies.

(Arch Intern Med. 1994;154:1497-1504)

Author Affiliations

From the Center for Research in Medical Education and Health Care and the Department of Medicine, Jefferson Medical College, Philadelphia, Pa (Drs Markson and Turner); and the Division of Health and Long Term Care, New York State Department of Social Services, Albany (Dr Cosier).

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