SHM data in quality of care research: Suzanne Geerlings & Esther Engelhard
It’s clear that Suzanne Geerlings has long been closely involved with quality of care. “By now I’ve looked at quality of care from many different angles, not only from the perspective of patient care, but also in my roles as chair of both the NVHB and NIV, and as a researcher. As an internal medicine specialist working on the ward, I would often question why something was done in a particular way, and would go on to look into it further and consider how the care could be improved. I also spent a lot of time looking into quality issues as chair of the NVHB, where I helped to draw up the standards for Dutch HIV treatment centres. These experiences have resulted in the formulation of various research questions. For example, since 2012 I have been supervising Esther Engelhard’s PhD research, in which she has sought to provide more scientific evidence to support the criteria set for Dutch HIV treatment centres.”
Scientific evidence
Esther explains the situation in the Netherlands further: “The Netherlands has set up special treatment centres for HIV-positive patients. These centres must meet certain criteria. This is quite unique and we believe it is beneficial in terms of healthcare outcomes, but currently this notion is based on expert opinion. Our literature research has shown that there is too much variation in methodology and that there are too many inconsistencies in the conclusions of the available scientific studies to be able to base policy decisions on these outcomes. Our study aims to address this issue and provide the required scientific evidence.
“For our study we carried out extensive analyses with SHM data and sent out questionnaires to patients and to the head physician of each centre. The information gathered from the head physicians provided a picture of how HIV care was organised in each particular centre (whether internal audits are carried out, which disciplines are represented in an HIV treatment team, how experienced doctors are, etc.) and how the various processes within a hospital are organised. For the latter, we used the ACIC (Assessment of Chronic Illness Care) questionnaire, which has been specially drawn up for chronic diseases. We used SHM’s data to make a reliable random selection for the patient survey. The results of this patient survey provided greater insight into how patients experience the current HIV care and what their needs are. Finally, SHM data also allowed us to effectively analyse the outcomes of all the surveys, linking patient factors (such as age, route of infection and presence of any comorbidities) with the anonymised answers to obtain a complete picture.”
The Netherlands is doing well
Esther continues, saying: “The good news is that our research shows that the Netherlands is doing relatively well in a number of areas compared, for example, to the United States, particularly when we look at retention in care and viral suppression across the centres. We believe this is largely because people are treated in specialised centres, although the final conclusions from this research are still to come.” Suzanne Geerlings adds: “Once these are available, the NVHB will have to consider, for example, whether to adjust the accreditation standards”.
Room for improvement
As well as the outcomes of Esther’s research, which should lead to improved guidelines for HIV care in the Netherlands, Suzanne Geerlings believes that there are two other important issues that warrant attention in the near future: “I think we need to take a better look at how we can make sure HIV-positive people are diagnosed more quickly. Furthermore, we need to focus on medical training to ensure that young doctors learn more about quality of care in general”.
“If you ask me what the most important issue is today, I would say earlier testing and thus earlier treatment. It is precisely those people who don’t know that they are infected or are not taking their medicine properly or at all who are maintaining the epidemic. This is why the H-TEAM (HIV Transmission Elimination Amsterdam) is now looking at how to ensure that the guidelines, which state that everyone is eligible for treatment, can be optimally implemented. For example, why isn’t everyone who has been diagnosed on therapy? We have found that a large part of the reason lies with the patient. Some patients, for example, need time to accept that they are HIV-positive. In addition, in terms of earlier testing, it is important to find out how we can ensure that general practitioners better recognise the high-risk patients and the signs of HIV, so that patients with a potential HIV infection are identified earlier. This is the subject of Ivo Joore’s PhD research, which I am supervising together with Jan van Bergen and Jan Prins”, says Suzanne Geerlings.
Quality of care as part of training
She continues: “As I said, I also think it’s very important that the medical training covers quality of care. There has recently been a move by the Dutch Council of Medical Specialists to address this. Although this does not, of course, focus specifically on HIV, the different disciplines share plenty of similarities. For example, it is important that each medical specialist sees a minimum number of patients to be able to recognise certain patterns or carry out certain operations. In addition, trainee doctors are being taught the increasing importance of patient perceptions and experiences. In other words, asking themselves not only ‘do I, as a doctor, think that the patient is improving?’, but also ‘do the patients themselves think that they are improving?’. Both aspects are also important in the field of HIV, and have already translated into specialised centres with an increasingly greater focus on the patient.”
All in all, following our conversation with Esther Engelhard and Suzanne Geerlings, we can conclude that f HIV care in the Netherlands is well organised, particularly compared to other parts of the world. However, when it comes to quality of care, there is always room for improvement.