Page 123 - Shared Guideline Development Experiences in Fertility Care

(Guideline-based) indicators for patient-centredness
Materials and Methods
Setting
In this study, the development of quality indicators for patient-centredness was based on a recently developed national multidisciplinary Network Guideline (NG) on infertility (www.nvog.nl). e guideline’s cornerstones consisted of a multidisciplinary approach to ensure proper alignment and special attention to patient-centredness of care. For this purpose, this NG was initially based on infertile patients’ clinical pathways and consisted of separate sections subject to di erent phases of care (e.g. care provided by General Practitioners (GPs), gynaecologists, urologists, psychologists and a er-care). Next, apart from the involvement of patients’ representatives in the guideline development group, a large group of infertile patients was involved in the development process. ey contributed to this process through their input in the formulation of key questions and through directly formulating and prioritizing recommendations on a wiki-based website [21]. Finally, the prioritized patients’ recommendations were literally integrated into the nal guideline and provided with a level P (Patients) evidence.
Dutch Fertility care
Overall, the Dutch fertility care has been publically arranged on three levels. Primary
care is provided by GPs and may comprise a part of an initial fertility assessment. Subsequently, a GP can refer couples to a gynaecologist in a general (secondary care)
or a university (tertiary care) hospital, who could then complete this initial fertility
assessment, determine a cause of infertility and de ne a suitable treatment plan. If a 6 severe male factor is diagnosed, couples can be referred to a urologist. Nurses, clinical biochemists and embryologists are also involved in assessments and preparations
for Medically Assisted Reproductive (MAR)-techniques, for instance IVF. In the Netherlands, IVF is carried out in 13 licensed clinics: 8 university hospitals, 4 general hospitals, and 1 private clinic. In clinics without an IVF-license (e.g. satellite clinics), professionals have the possibility to start up and monitor ovarian stimulation, but they have to refer to a licensed clinic for the retrieval of oocytes and embryo transfers. Additionally, in transport clinics, the ovarian stimulation and retrieval of oocytes can be performed initially, but retrieved oocytes have to be transported to the central IVF laboratory of a licensed clinic. Since infertility has a high emotional and psychological impact, which may also interfere with people’s jobs, psychologists and occupational physicians are regularly involved in the clinical pathway.
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