value based health care - virology...
TRANSCRIPT
Value Based HIV Care / Quality of life in HIV:
Lessons learned from implementation
Barcelona 07-09-2018
Guido van den Berk
HIV cascade of care NL 2016
HIV monitoring report 2017
HIV Cascade of care OLVG 2014-2017
HIV CARE IN OLVG“ beyond undetectable / fourth 90”
• Patient centered care
- “Valuable parameters”
- Quality of life
- Patient control (Happi App)
• Cost effective
• Continuous improvement
HIV care pathPATIENT / PROMS
nurse
INTERNIST
4 mo 1 month 8 mo 12 mo
Intake nurse PROMS PROMS PROMS
yearly check
Internist
PROMS
yearly check
Internist
Nurse
Internist
6 mo 12 mo
or
Internist Internist
Internist
PROMS
1st year
chronic care
VBHiC outcome indicators
Tier 1 Tier 2 Tier 3
1) Undetectable hiv load
within the first year of care entry
4) Retention in care 8) Quality of life (QoL*)
after 5 years
2) Quality of life (QoL*)
within the first year of care entry
5) Therapy effectiveness (persistent viremic control) 9) Overall mortality
3) Mortality
within the first year of care entry
6) Therapy tolerance
7)Cardiovascular risk
Quality improves
Quality improves
Quality of life in HIV
• Validated questionnaires
• Domains that influence physical and mental health
• Routine questionnaires in care path
– Preferrably via EMR / Hiv app Happi ®
– Eventually on paper
– Dutch and English
QoL Questionnaires (62 items)
• Short Form Health Survey (SF-12)
• Hospital Anxiety & Depression Score (HADS)
• short Stigma scale (Berger)
• Social Support List (SSL-12)
• Sexual Difficulties (~ Natsal-SF)
• Single item measuring Self Esteem (SISE)
• Sleep difficulties (SCL-90-R)
• Medication tolerance
Quality of life patient level
HIV CARE IN OLVG“ beyond undetectable / fourth 90”
• Patient centered
- “ Valuable parameters”
- Quality of life
- Patient control (Happi App)
• Cost effective
• Continuous improvement
Less consultations despite more patients
2012 2013 2014 2015 2016 2017
2.000
4.000
6.000
8.000
10.000
12.000
500
1000
1500
2000
2500
3000
3500
4000
2012 2013 2014 2015 2016 2017
Am
ou
nt
of
cun
sult
atio
ns
Am
ou
nt
of
pat
ien
ts
Jaar
Amount of consultations and amount of patients per year
Amount ofpatients
Amount ofconsultations
Less overall costs despite more patients
2012 2013 2014 2015 2016 2017
2.000
4.000
6.000
500
1000
1500
2000
2500
3000
3500
4000
2012 2013 2014 2015 2016 2017
Am
ou
nt
of
cun
sult
atio
ns
Am
ou
nt
of
pat
ien
ts
Jaar
Cost reduction and patient growth
Amount ofpatients
Cost reduction
€
€
€
€
€
€
€
€
HIV CARE IN OLVG“ beyond undetectable / fourth 90”
• Patient centered
- “ Valuable parameters”
- Quality of life
- Patient control (Happi App)
• Cost effective
• Continuous improvement
Aiming for continuous improvement
• Monitoring at – Patient level– Population level – Process level
• VBHiC improvement meeting one hour every month
• Chaired by working group
• Each working group responsible for one outcomeindicator
Example: HADS at population level
HADS anxiety HADS depression HADS total
25%
How to improve hiv mental health ?
Right (amount of) QoL questions ?
What interventions needed ?
Implementing hiv mental health care path
HADS > 12: exploration by hiv nurse
Multidisciplinary meeting with psych
Dual consultation psych/hiv nurse ?
Referral psych ?
Stigma PhD
Improving mental health
Patient management at process level
Lessons learned• “ Holistic approach” very much appreciated by patients
• Feasible
• Datamanager necessary, ideally good EMR database
• Get everybody involved– Patients (past-present-future)– Caregivers (everybody) – Health insurance (bundle payment)– IT department– ICHOM / HIV outcome initiative
• Learn from each other; benchmarking – Within one centre (retrospectively, amongst caregivers)– Between hiv centres– HIV outcome initiative
• It takes time / perseverance
Thank you for your attention !
Guido van den Berk ([email protected])
On behalf of
All patients
The OLVG HIV team
And especially the VBHiC OLVG team: Kees Brinkman
Marie-Jose Kleene
Narda van der Meche
Daoud ait Moha
Martje Dermer
Tino Bekkering
Jacqueline Platen