Perceived facilitators and barriers in diabetes care: a qualitative study among health care professionals in the Netherlands

Lieke Gm Raaijmakers,Stef Pj Kremers,Nanne K De Vries,Femke Jm Hamers,Marloes K Martens,Charlotte Bagchus

doi:10.1186/1471-2296-14-114

Abstract

BackgroundThe need to understand barriers to the implementation of health care innovations in daily practice has been widely documented, but perceived facilitators and barriers in diabetes care by Dutch health care professionals remain unknown. The aim of this study was to investigate these factors among health care professionals (HCPs) using a qualitative research design.MethodsData were collected from 18 semi-structured interviews with HCPs from all professions relevant to diabetes care. The interviews were recorded and transcribed verbatim and the data were analyzed using NVivo 8.0.ResultsMajor facilitators were the more prominent role of the practice nurses and diabetes nurses in diabetes care, benchmarking, the Care Standard (CS) of the Netherlands Diabetes federation and multidisciplinary collaboration, although collaboration with certain professional groups (i.e. dieticians, physical therapists and pharmacists), as well as the collaboration between primary and secondary care, could still be improved. 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 were reported to be the lack of motivation among patients and the lack of awareness of lifestyle programs and prevention initiatives for diabetes patients among professionals.ConclusionsOrganizational changes in diabetes care, as a result of the increased attention given to management continuity of care, have led to an increased need for multidisciplinary collaboration within and between health care sectors (e.g. public health, primary care and secondary care). To date, daily routines for shared care are still sub-optimal and improvements in facilities, such as registration systems, should be implemented to further optimize communication and exchange of information.

Highlights

The need to understand barriers to the implementation of health care innovations in daily practice has been widely documented, but perceived facilitators and barriers in diabetes care by Dutch health care professionals remain unknown
Community resources and policies One of the facilitating factors perceived by several health care professionals (HCPs) (PN1, DN1, PT1, IP1) in the community was the increased attention to diabetes in health care and the media
One respondent (PN2) reported not to have a list of local exercise facilities and another respondent (PT2) agreed that they have to look for opportunities in the neighborhood themselves using their personal network

Summary

Introduction

The need to understand barriers to the implementation of health care innovations in daily practice has been widely documented, but perceived facilitators and barriers in diabetes care by Dutch health care professionals remain unknown. The prevalence of diabetes in the Netherlands in 2011 was 801.000 and this number increased by 87,000 patients each year, thereby approaching 1 million (6% of the total population) [2]. 45,000 men and 42,000 women (5,5 per 1.000 men and 4,9 per 1.000 women) In addition to these diagnosed patients, registration data in general practice showed that an estimated 25% of the patients is as yet undiagnosed in the Netherlands [3]. Reasons for this number of undiagnosed patients are amongst others the lack of attention of professionals for early symptoms of diabetes [4]. Data on the prevalence of diabetes in nursing homes and on the prevalence of diabetes type 2 among children and adolescents appears to be lacking [4]

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