Perceptions of Dutch health care professionals regarding the Care Standard for diabetes

Abstract

BackgroundThe Netherlands can be regarded as unique in the use of the Netherlands Diabetes Federation (NDF) Care Standard (CS) for diabetes. The need to understand the barriers obstructing optimal health care, the dissemination and implementation of health care innovations into daily practice and the extent to which health care professionals actually adhere to guidelines has been emphasized repeatedly. Therefore, the aim of the present study was to suggest ways to optimize the implementation of the CS by examining the perceptions of Dutch health care professionals regarding the CS and the barriers to using it.MethodsA cross-sectional questionnaire survey was conducted among health care professionals (N = 1547) in 2010.ResultsA total of 39.6% (N = 1323) of the participating health care professionals possessed the CS. Only 15.5% of the professionals who were to some extent familiar with the CS (N = 1100) described themselves as working in complete accordance with the CS. The majority (83.9%) thought the CS contributed greatly to ensuring the quality of care; the judgment on the feasibility of working in accordance with the CS was positive (mean = 3.9 on a 5-point Likert scale). However, professionals tended to perceive the guidelines issued by the own professional association as the norm for high quality diabetes care, rather than the CS. The main barrier to using the CS was the lack of effective lifestyle interventions (or access to them) to provide care for people with diabetes or those at increased risk for the disorder.ConclusionsA limited percentage of health care professionals were found to posses the CS. It is questionable whether possession of the CS is a prerequisite for delivering high quality care. Overall, professionals were largely positive about the CS, although only a minority indicated they were working in complete accordance with it. Professionals and professional organizations should be further educated about the content of the CS and especially its added value with respect to the guidelines for their own professional group, in terms of the multidisciplinary approach to diabetes care. Furthermore, attention should be given to the most important perceived barriers, to facilitate adherence to the CS.

The implementation of national action program diabetes in the Netherlands: lessons learned

“…The semi-structured interviews revealed several facilitators and barriers perceived by HCPs in diabetes care [ 18 ]. One of the major facilitators was the more prominent role of the practice nurses and diabetes nurses in diabetes care, as a result of the substitution of care.…”

“…The bundled payment system for the funding of diabetes care and the role of the health insurers were perceived as major barriers within the health care system. Other important barriers reported by HCPs were the lack of motivation among patients and the lack of awareness among professionals of lifestyle programs and prevention initiatives for diabetes patients [ 18 ].…”

“…In 2010, two cross-sectional studies were performed, in which questionnaires were distributed among all HCPs involved in diabetes care [ 20 ] (i.e. general practitioners, practice nurses, diabetes nurses, dieticians, physiotherapists, internal medicine physicians, pediatricians and pharmacists; N = 1726) and type 1 and type 2 diabetes patients (N = 573) [ 18 , 21 ]. In addition to the published results of this study [ 18 , 21 ], independent t-tests were conducted to determine significant differences in the implementation of several elements of the CS between HCPs who were in possession of the CS and HCPs who were not in possession of the CS.…”

“…Participants were randomly selected from the database of the quantitative study conducted among HCPs in 2010 [ 17 , 21 ]. The results of these interviews are already published [ 16 , 18 ]. In March and April 2014, four semi-structured interviews were held with directors/managers of care groups or collaborations of health care centers.…”

“…For a detailed description of the recruitment and measurement instruments of the separate studies we refer to the studies of Raaijmakers et al [ 16 - 18 , 21 ] and Martens et al [ 19 , 23 ]. Ethical approval for the included studies was not required under Dutch law [ 24 ].…”