Improving guideline compliance for quality HIV care

A recent qualitative study identified factors that influence guideline compliance to the Dutch HIV treatment guidelines for laboratory testing in outpatient HIV care in the Netherlands.

Evidence-based HIV care guidelines outline recommendations for health care providers to guide the clinical management of patients living with HIV. Data around HIV care and treatment in the Netherlands is collected and published through Stichting HIV Monitoring (SHM). The annual HIV Monitoring Report includes a chapter on quality of care indicators that are based on the national HIV treatment guidelines and allow for benchmarking between the 26 clinics providing HIV care in the country.

It was through this annual monitoring and reporting that the SHM researchers noticed a variation between centers in guideline compliance with respect to monitoring for laboratory markers during patient follow up.

To gain a better understanding as to why the laboratory monitoring guidelines were being utilized differently, the team performed qualitative interviews with physicians from some of the treatment centers. A number of AIGHD team members, including social scientists, a Master’s intern and academic staff, led the study.

Overall, physicians perceived the guidelines to be helpful in delivering care to patients and through their interviews, identified a number of areas for improvement. Some of the challenges they identified included unclear online visual representation of the guidelines and a lack of pre-programmed reminders for requesting certain tests. Furthermore, the physicians pointed out that some tests were dependent on a patient’s age or assessment of their sexual risk-taking behavior, and that task division in terms of the responsibility for ordering tests between general practitioners, municipal health services and HIV treatment centers was not always clear.

“The interviews provided valuable insight into some of the key barriers when it comes to implementing the guidelines. Recommendations based on the physicians’ feedback will be passed onto policy makers for consideration to enhance the guidelines and ultimately, ensure that patients continue to receive the highest quality of care while ensuring cost effectiveness in terms of the resources used,” said Dr. Sonia Boender, infectious disease epidemiologist and public health researcher and lead on the study.

For Dieuwke Toxopeus, who recently graduated from Vrije University with a Master of Science in Management, Policy Analysis and Entrepreneurship in Health and Life Sciences and interned at AIGHD and Stichting HIV Monitoring as part of the study, the research was particularly meaningful.

“My research internship at AIGHD and SHM was a great experience not only because I graduated from my Master’s program by completing this study, but especially because I learned a lot about the academic world during the process of publishing this study for AIDS Care,” said Dieuwke.  “I received a warm welcome at SHM from my supervisor and co-authors and they were very helpful throughout the process of publishing the study.”

Photo caption: Dr. Sonia Boender (L) and Dieuwke Toxopeus at Dieuwke’s Master’s graduation. [Photo courtesy of Dr. Boender]

Read the full publication.