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Rural Human Immunodeficiency Virus Care
The excellent article by Mainous and Matheny1 In the September 1996 issue of the ARCHIVES documented the extraordinary efforts of many human immunodeficiency virus (HIV)–infected patients living in rural areas in obtaining health care; these patients often traveled across the state to a major medical center. Not unexpectedly, but of concern, was that many of these patients did so because they believed their local physicians were unable to provide proper HIV care. This is a reasonable concern for patients and their physicians.
Nevertheless, some patients do remain "at home" under the care of their local physicians, although the study by Mainous and Matheny was unable to estimate the size of this patient or provider population. The preliminary results of a survey we conducted of rural physicians in California suggest that the availability of telephone consultation from local, regional, university, or national experts is an important determinant of whether primary care physicians remain involved in and are comfortable with the care of patients with HIV or the acquired immunodeficiency syndrome.
We want to make ARCHIVES readers aware of our National HIV Telephone Consultation Service (Warmline), a service of the Health Resources and Services Administration's AIDS Education and Training Centers and the American Academy of Family Physicians for supporting physicians and other health care providers (principally nurses, pharmacists, nurse practitioners, and physician assistants). Staff of the Warmline (1-800-933-3413) answer calls Monday through Friday, 7:30 AM to 5 PM Pacific standard time, and provide consultation, education, and advice for providers who care for patients with HIV. Since the service began 4 years ago, 75 calls have been received from Kentucky. Louisville and Lexington account for 32 of the calls, but the 43 remaining calls were from small towns and rural areas, mostly from primary care providers. Although some of these calls were for general information about HIV or the acquired immunodeficiency syndrome, most were for guidance regarding patient management, especially regarding appropriate antiretroviral therapy and the prophylaxis or treatment of opportunistic infections. Others concerned terminal care, as many persons from rural areas "return home" in the terminal phases of their illness.2 The benefits of primary care "at home" have not yet been evaluated but are also worthy of study. Our experience supports the concerns expressed by Green (in the accompanying "Practice Commentary")3 that an improved physician knowledge base will not be sufficient to produce ideal health care. Indeed, a dialogue around management options and the most suitable case-specific course remains central to the care of patients with HIV or the acquired immunodeficiency syndrome, as there are constantly evolving treatment strategies. By providing this backup for local physicians, the Warmline and other telephone consultation services also help many patients remain with their own family, community, and family physician or other primary care clinician.
AUTHOR INFORMATION
Dr Goldschmidt is the director and Dr Liljestrand is the evaluator of the Health Resources and Services Administration's AIDS Education and Training Centers' National HIV Telephone Consultation Service.
Ronald H. Goldschmidt, MD;
Cynthia L. Willard, MD;
Petra Liljestrand, PhD
San Francisco General Hospital
San Francisco, Calif
1. Mainous III AG, Matheny SC. Rural human immunodeficiency virus health service provision: indications of rural-urban travel for care. Arch Fam Med. 1996;5:469-473.
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2. Verghese A, Berk SL, Sarubbi F. Urbs in rure: human immunodeficiency virus infection in rural Tennessee. J Infect Dis. 1989;160:1051-1055.
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3. Green LA. Practice commentary. Arch Fam Med. 1996;5:473.
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Arch Fam Med. 1998;7:14.
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