Doctors' experience held vital with AIDS Washington state study finds patients live longer with veteran doctors


WASHINGTON -- The length of time a patient survives with AIDS is directly linked to a doctor's experience in treating the disease, according to a study reported yesterday at a scientific meeting.

After AIDS was diagnosed, median survival among patients of doctors with the most experience with AIDS was 26 months, compared with 14 months for those treated by the least experienced doctors.

The study involved more than 400 patients treated by 125 primary-care doctors from 1984 to 1994 at the Group Health Cooperative of Puget Sound, a health maintenance organization based in Seattle.

The study was conducted by researchers from the University of Washington, who said they believed that the findings pointed up the need to improve health-care delivery and physician education to gain maximum benefit from AIDS care.

Earlier studies have found that hospitals admitting higher numbers of AIDS patients have a lower death rate than those admitting fewer patients. Dr. Mari Kitahata, the head of the research team, said the new study supports the concept that "practice makes perfect."

The study was undertaken because many doctors have had no formal training in treating AIDS, which was first recognized in 1981, and the standards of care have rapidly changed and continue to do so. Moreover, many patients are cared for by primary-care doctors, not specialists in infectious diseases.

The Seattle researchers took into account the AIDS experience that the doctors in the cooperative had in their training programs and medical practice, as well as the severity of illness of the patients they treated and changes in AIDS care over the 10 years that the study covered.

The study found that all doctors went through a comparable learning period. There was a decreasing risk of death for each successive patient after the first. About one-third of the doctors treated just one AIDS patient during the study period.

Dr. Kitahata cited three areas in which experienced doctors monitored AIDS patients more closely or treated them more aggressively than their less experienced colleagues.

One was in monitoring the number of CD-4 cells, the specialized white cells in the blood that play a crucial role in the immune system. A declining CD-4 count is often used to guide therapy for a patient with HIV, the virus that causes AIDS.

A second area was in prescribing drugs to prevent development of pneumocystis carinii pneumonia, a common complication of AIDS that is a major cause of death among AIDS patients. Patients treated by the most experienced doctors had fewer diagnoses of this form of pneumonia as their first AIDS illness.

The third area was in providing more aggressive anti-HIV therapy. "Our study demonstrates the importance of experience among generalists managing patients with AIDS," Dr. Kitahata said.

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