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

Objective: To determine the organisational and personal barriers to the imp lementation of diabetes guidelines in hospitals in The Netherlands and rela te them to structural factors of diabetes care. Method: In a written survey internists specialised (or with a specific inte rest) in diabetes in all general hospitals in The Netherlands (n = 120) wer e asked to indicate the perceived organisational and personal barriers to a dherence to the diabetes guidelines. In the same questionnaire their activi ties related to diabetes care and the working hours of the additional perso nnel involved were measured. Results: 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 c onsultation hours for diabetic patients, had a protocol for diabetes treatm ent, ol 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. Conclusion: A number of preconditions for structured diabetes care, like th e presence of a diabetes team and a specialised diabetes nurse, were in pla ce. However, large differences between the hospitals in the organisation of diabetes care and the availability of staff, together with the related per ceived barriers to the implementation of the guidelines showed that there a re still many opportunities for improvements, (C) 2000 Elsevier Science B.V . All rights reserved.