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Abstract：
BACKGROUND: One of the aims of value-based healthcare (VBHC) is to deliver more patient-centred care. However, little is known about the effect of VBHC interventions on patient experiences. We aim to explore how patients experience VBHC as implemented in an HIV outpatient clinic in an academic hospital in the Netherlands.
METHODS: The HIV outpatient clinic of the Erasmus MC, Rotterdam, the Netherlands, an academic tertiary hospital, implemented a VBHC intervention consisting of 1) implementation of a generic quality of life questionnaire, administered before each visit, 2) a change in consultation schedule; from twice a year face-to-face to one face-to-face double consultation and one remote consultation per year, and 3) a change in consultation structure; from a single face-to-face consultation with the infectious diseases (ID) specialist to a double consultation in which the patient visits both the nurse and the ID specialist. Semi-structured interviews were held with Dutch or English-speaking adult patients, that had been a patient within Erasmus MC for more than 5 years, on their experiences with the implemented changes.
RESULTS: Thirty patients were interviewed. Patients had no objections towards completing the questionnaires especially if it could provide the professionals with additional information. Patients were primarily positive about the change in consultation schedule. For the yearly remote consultation they preferred a telephone-consultation above a video-consultation. The change in consultation structure ensured that more topics, including psychosocial and medical aspects could be discussed. Some patients did not see the added value of talking to two professionals on the same day or completing the quality of life questionnaire before their consultation.
CONCLUSIONS: Patients are generally positive towards the VBHC interventions implemented at the HIV outpatient clinic. Our findings may inform further optimization of VBHC interventions and improve patient-centred care in outpatient HIV clinics.
METHODS: The HIV outpatient clinic of the Erasmus MC, Rotterdam, the Netherlands, an academic tertiary hospital, implemented a VBHC intervention consisting of 1) implementation of a generic quality of life questionnaire, administered before each visit, 2) a change in consultation schedule; from twice a year face-to-face to one face-to-face double consultation and one remote consultation per year, and 3) a change in consultation structure; from a single face-to-face consultation with the infectious diseases (ID) specialist to a double consultation in which the patient visits both the nurse and the ID specialist. Semi-structured interviews were held with Dutch or English-speaking adult patients, that had been a patient within Erasmus MC for more than 5 years, on their experiences with the implemented changes.
RESULTS: Thirty patients were interviewed. Patients had no objections towards completing the questionnaires especially if it could provide the professionals with additional information. Patients were primarily positive about the change in consultation schedule. For the yearly remote consultation they preferred a telephone-consultation above a video-consultation. The change in consultation structure ensured that more topics, including psychosocial and medical aspects could be discussed. Some patients did not see the added value of talking to two professionals on the same day or completing the quality of life questionnaire before their consultation.
CONCLUSIONS: Patients are generally positive towards the VBHC interventions implemented at the HIV outpatient clinic. Our findings may inform further optimization of VBHC interventions and improve patient-centred care in outpatient HIV clinics.
摘要：
背景：基于价值的医疗保健（VBHC）的目标之一是提供更多以患者为中心的护理。然而,关于VBHC干预对患者体验的影响知之甚少。我们的目标是探索患者如何在荷兰一家学术医院的HIV门诊诊所中体验VBHC。
方法：ErasmusMC的HIV门诊诊所，鹿特丹,荷兰,一所学术的三级医院，实施了VBHC干预，包括1)实施通用生活质量问卷，在每次访问之前管理，2)更改咨询时间表；从每年两次面对面咨询改为每年一次面对面双重咨询和一次远程咨询，和3）咨询结构的变化；从与传染病（ID）专家的单一面对面咨询到患者同时拜访护士和ID专家的双重咨询。对讲荷兰语或英语的成年患者进行了半结构化访谈，在ErasmusMC中做了5年多的病人,关于他们实施变革的经验。
结果：对30名患者进行了访谈。患者对填写问卷没有异议，特别是如果它可以为专业人员提供更多信息。患者主要对咨询时间表的变化持积极态度。对于每年的远程咨询，他们更喜欢电话咨询，而不是视频咨询。协商结构的变化确保了更多的议题，包括社会心理和医学方面可以讨论。一些患者没有看到在同一天与两名专业人员交谈或在咨询前完成生活质量问卷的附加值。
结论：患者通常对在HIV门诊诊所实施的VBHC干预措施持积极态度。我们的发现可能会进一步优化VBHC干预措施，并改善门诊HIV诊所以患者为中心的护理。
方法：ErasmusMC的HIV门诊诊所，鹿特丹,荷兰,一所学术的三级医院，实施了VBHC干预，包括1)实施通用生活质量问卷，在每次访问之前管理，2)更改咨询时间表；从每年两次面对面咨询改为每年一次面对面双重咨询和一次远程咨询，和3）咨询结构的变化；从与传染病（ID）专家的单一面对面咨询到患者同时拜访护士和ID专家的双重咨询。对讲荷兰语或英语的成年患者进行了半结构化访谈，在ErasmusMC中做了5年多的病人,关于他们实施变革的经验。
结果：对30名患者进行了访谈。患者对填写问卷没有异议，特别是如果它可以为专业人员提供更多信息。患者主要对咨询时间表的变化持积极态度。对于每年的远程咨询，他们更喜欢电话咨询，而不是视频咨询。协商结构的变化确保了更多的议题，包括社会心理和医学方面可以讨论。一些患者没有看到在同一天与两名专业人员交谈或在咨询前完成生活质量问卷的附加值。
结论：患者通常对在HIV门诊诊所实施的VBHC干预措施持积极态度。我们的发现可能会进一步优化VBHC干预措施，并改善门诊HIV诊所以患者为中心的护理。
