Background In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. Methods GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. Findings GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04–1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63–1.19). HIV testing increased most among patients who were female and ≤19 or 50–64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01–1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05–1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97–0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. Conclusions The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
Within large service organizations there are currently two trends visible. These trends seem to be diametrically opposed. On the one hand organizations face increasing price pressure and thus a pressure to cut costs. One of the consequences of this trend is that organizations are increasingly encouraging customers to make more use of digital communication channels. At the same time, companies find it important to know their customers in order to respond adequately to their needs. To do this, organizations must have a certain degree of personal involvement to their customers and they must have regular personal contact. It is assumed that both trends – digitisation and personalisation – will have a strong impact on customer experience and (perhaps) on the relational models customers use. If it is true that relational models - so the way in which people perceive and assess a relationship - play a role in the perception of the customer, it is also interesting to know if it is possible to influence these relational models. During the last fifty years much research has been done into the possibilities to influence customers by using subliminal priming techniques. In these techniques thoughts and feelings are unconsciously activated by showing people certain words or images (eg Bargh, Chen & Burrows, 1996; Dijksterhuis, 2005). In recent years a number of experiments were performed in which customers were unconsciously primed at some type of relationship (eg Aggarwal, 2004; McGraw & Tetlock, 2005; Tuk, Verlegh, Smidts & Wigboldus, 2009). These experiments showed that it is possible to activate a certain type of relationship. The experiments however the researchers used scenario’s based on an interpersonal relationship, and often to a fictitious relationship. The question is whether priming techniques also work for an already existing and more complex relationship between an organization and its customers. From 2010-2013 we conducted research for six large service providers in banking, insurance, utilities and social welfare to discover what the customer experience of these organisations, what role relational models played in customer experience and whether it was possible to influence these relational models. The research project has provided answers to the following questions: - Which relational models are used by customers and what is the influence of these models on customer experience? - What is the influence of digitisation in customer communication on relational models and customer experience? - What is the influence of personalisation in customer communication on relational models and customer experience? And finally, - Is it possible to influence relational models (and customer experience) by using specific words and images that are associated with relational models (relational framing)?
