Presentation from Jenny Hoy (Alfred Hospital) regarding enmeshing quality improvement in routine HIV care.
One example covered was syphilis testing - recommendation that syphilis serology done with all HIV VL tests. Initial audit suggested only 25% or less of cases of HIV VL testing at Alfred were accompanied by syphilis serology. Response with clinician education was effective in improving testing to around 50%, but not durably so (decreased again after 1year). An individual clinician audit approach was more effective, and changing the system to 'opt out' (syphilis testing needed to be crossed off for it not to be done), proved successful. Food for thought regarding clinician behaviour and testing algorithms. When is an 'opt out' approach appropriate? And how does it impact on clinician responsibilities, patient rights, and health outcomes?
The next example presented by Prof Hoy concerned screening and management of HT by clinicians. Re-education was required for doctors to check BP, however surprise to realise that re-education was subsequently required to get them to do anything about the results! An important lesson, particularly given the aging HIV infected population - as presented in the last session I attended (Theme B this morning at 11:15am) and the new comorbidity focus on illnesses associated with aging including cardiovascular disease, bone mineral density changes and cognitive impairment. HIV clinician-gerontologists are uncommon, but at the very least HIV clinicians need to expand their skill sets to optimise their abilities to manage the new comorbidities seen in their patient populations.
One of the important messages presented in this talk was that audit is required to improve quality of care - shortfalls may thereby be identified at individual provider, setting and state and national levels. Quality improvement needs to be integrated into care. To make changes durable however is the next challenge.
Finally, she discussed the barriers to Quality of care, for example-the importance of setting standards for quality, as is seen in the European Guidelines , for care of PLHIV. We do not have these in Australian guidelines at the moment.
"Quality of life is inextricably linked to the quality of care that we deliver".