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Neth J Med. 2000 Mar;56(3):80-5.

Perceived barriers to the implementation of diabetes guidelines in hospitals in The Netherlands.

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Centre for Quality of Care Research (WOK), University of Nijmegen, The Netherlands.



To determine the organisational and personal barriers to the implementation of diabetes guidelines in hospitals in The Netherlands and relate them to structural factors of diabetes care.


In a written survey internists specialised (or with a specific interest) in diabetes in all general hospitals in The Netherlands (n = 120) were asked to indicate the perceived organisational and personal barriers to adherence to the diabetes guidelines. In the same questionnaire their activities related to diabetes care and the working hours of the additional personnel involved were measured.


There was at least one specialised diabetes nurse employed in all hospitals, although the extent of the appointment varied widely from 0.2 to 6.9 full-time equivalent (average 1.5). In most hospitals (90%) a diabetes care team had been established, while podiatrists were working in only 72% of the hospitals. Furthermore, 65-80% of the hospitals organised special consultation hours for diabetic patients, had a protocol for diabetes treatment, or patient held administration booklets. The most frequently mentioned barriers to the implementation of diabetes guidelines were high workload, no adequate financial compensation, and a shortage of necessary personnel.


A number of preconditions for structured diabetes care, like the presence of a diabetes team and a specialised diabetes nurse, were in place. However, large differences between the hospitals in the organisation of diabetes care and the availability of staff, together with the related perceived barriers to the implementation of the guidelines showed that there are still many opportunities for improvements.

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