Patients and nurses determine variation in adherence to guidelines at Dutch hospitals more than internists or settings

• Published in: Diabetic medicine 2004-06, Vol.21 (6), p.586-591
• Main Authors: Dijkstra, R. F., Braspenning, J. C. C., Huijsmans, Z., Peters, S., Van Ballegooie, E., Ten Have, P., Casparie, A. F., Grol, R. P. T. M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Body Mass Index; diabetes mellitus; Diabetes Mellitus - therapy; diabetes specialist nurse; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Eye; Female; Foot; guideline adherence; Humans; Male; Medical sciences; Medical Staff, Hospital; Middle Aged; Nursing Care - standards; Outcome and Process Assessment (Health Care) - standards; Patient Compliance; Patient Education as Topic; Physical Examination; Practice Guidelines as Topic
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2004.01195.x

Aims  To measure adherence to recently developed diabetes guidelines at Dutch hospital outpatient clinics and distinguish determinants for variations in care on hospital, internist and patient levels. Methods  Thirteen general hospitals with 58 internists recruited 1950 diabetic patients. Data were extracted from medical files (n = 1915) and from patient questionnaires (n = 1465). Multilevel logistic regression analysis was performed to explain differences in adherence rates to the guidelines. Results  Adherence to process measures was high, except for the examination of feet, calculation of the body mass index and patient education activities (the mean of 12 process measures was 64%). Adherence to intermediate outcome indicators was moderate. The mean percentage of patients with HbA1c