New study examines quality of care
Esther Engelhard is a PhD student from the AMC in Amsterdam. Based out of the Stichting HIV Monitoring (SHM) offices, she is coordinating a new study examining the quality of HIV care in the Netherlands. In the following article she discusses the study in further detail.
The Q-HIV study started recently. Subsidised by the AIDS Fonds, the study is titled ‘Optimisation of quality of care for HIV-positive patients in care in HIV Treatment Centres in the Netherlands’. The study examines the factors that influence the quality of care provided by the Dutch HIV Treatment Centres.
HIV Care
The life expectancy of patients infected with HIV has increased greatly since the introduction of combination antiretroviral therapy (cART). The care of HIV-infected patients, however, remains complex principally because patients must follow life-long therapy, where therapy adherence is essential. The impact of living with a chronic disease and the potential adverse effects of cART can have a negative effect on adherence, increasing the risk of therapy failure and the development of viral resistance. In addition, as we are dealing with an aging population of HIV-infected patients, comorbidities are becoming more prevalent.
Objectives of the study
In 2001, the Minister of Health, Welfare and Sport followed the advice of the Health Council to determine that HIV care should be provided by specialised treatment centres. The criteria the treatment centres must satisfy are based on expert opinion. The purpose of this study is to scientifically validate the criteria of quality of HIV care in the Netherlands. The study examines which factors (hospital-, professional- and patient-related) influence the quality of HIV care. Furthermore, the study examines quality of care from the patients’ perspective and the quality of life of HIV-infected patients.
Additional questions include: What is the optimal frequency for monitoring patients between entry into care and starting cART? What are the predictors for late start of cART after early entry into care and what is the effect on treatment outcome? What is the impact of a late versus an early change of cART regimen? What can be used to predict the rate of change in CD4 cell count?
The research structure
Quality of care is measured using quality indicators (developed in the context of Zichtbare Zorg Ziekenhuizen, translation: Visible Care hospitals), clinical data from the SHM Database and additional data collected using questionnaires. To research the determinants at hospital-level, all HIV Treatment Centres will receive a questionnaire. A number of patients will be approached to research the quality of care and the quality of life from the patient’s point of view. For additional study questions, data collected by SHM will be analysed.
Q-HIV study project team:
Esther Engelhard (study coordinator), Colette Smit, Kees Brinkman, Frank Kroon, Pythia Nieuwkerk, Marlies Hulscher, Frank de Wolf, Suzanne Geerlings (project leader).