Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study

Authors: Sandra F Oude Wesselink, Hester F Lingsma, Paul BM Robben, Johan P Mackenbach

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

Background

The complex disease of diabetes mellitus type 2 (T2DM) requires a high standard of quality of care. Clinical practice guidelines define norms for diabetes care that ensure regular monitoring of T2DM patients, including annual diagnostic tests. This study aims to quantify guideline adherence in Dutch general practices providing care to T2DM patients and explores the association between guideline adherence and patients’ health outcomes.

Methods

In this cross-sectional study, we studied 363 T2DM patients in 32 general practices in 2011 and 2012. Guideline adherence was measured by comparing structure and process indicators of care with recommendations in the national diabetes care guideline. Health outcomes included biomedical measures and health behaviours. Data was extracted from medical records. The association between guideline adherence and health outcomes was analysed using hierarchical linear and logistic regression models.

Results

Guideline adherence varied between different recommendations. For example 53% of the practices had a system for collecting patient experience feedback, while 97% had a policy for no-show patients. With regard to process indicators of care, guideline adherence was below 50% for foot, eye and urine albumin examination and high (>85%) for blood pressure, HbA1c and smoking behaviour assessment. Although guideline adherence varied considerably between practices, after adjusting for patient characteristics we found guideline adherence not to be associated with patients’ health outcomes.

Conclusions

Guideline adherence in Dutch general practices offering diabetes care was not optimal. Despite considerable variations between general practices, we found no clear relationship between guideline adherence and health outcomes. More research is needed to better understand the relationship between guideline adherence and health outcomes, specifically for guidelines that are based on limited scientific evidence.
Appendix
Available only for authorised users
Literature
1.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2013;36 suppl 1:S11–66.CrossRef
2.
Sidorenkov G, Haaijer-Ruskamp FM, De Zeeuw D, Denig P. A longitudinal study examining adherence to guidelines in diabetes care according to different definitions of adequacy and timeliness. PLoS One. 2011;6(9):e24278.CrossRefPubMedPubMedCentral
3.
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318(7182):527.CrossRefPubMedPubMedCentral
4.
Dutch Diabetes Federation (Nederlandse Diabetes Federatie): NDF Care Standard (NDF Zorgstandaard). Amersfoort 2007.
5.
Harman JS, Scholle SH, Ng JH, Pawlson LG, Mardon RE, Haffer SCC, et al. Association of Health Plans' Healthcare Effectiveness Data and Information Set (HEDIS) performance with outcomes of enrollees with diabetes. Med Care. 2010;48(3):217–23.CrossRefPubMed
6.
Selby JV, Uratsu CS, Fireman B, Schmittdiel JA, Peng T, Rodondi N, et al. Treatment intensification and risk factor control: toward more clinically relevant quality measures. Med Care. 2009;47(4):395–402.CrossRefPubMedPubMedCentral
7.
Sidorenkov G, Voorham J, de Zeeuw D, Haaijer-Ruskamp FM, Denig P. Treatment quality indicators predict short-term outcomes in patients with diabetes: a prospective cohort study using the GIANTT database. BMJ Qual Saf. 2013;22(4):339–47.CrossRefPubMed
8.
Struijs JN, Baan CA. Integrating care through bundled payments—lessons from The Netherlands. N Engl J Med. 2011;364(11):990–1.CrossRefPubMed
9.
Wood M, Lamberts H. International Classification of primary care: prepared for the World Organisation of national colleges, academies and academic associations of general practitioners/family physicians (WONCA) by the ICPC Working Party. Oxford: Oxford University Press; 1987.
10.
11.
12.
Verbeke G, Molenberghs G: Linear mixed models for longitudinal data. Springer Verlag; 2009
13.
de Koning JS, Klazinga NS, Koudstaal PJ, Prins A, Borsboom GJJM, Mackenbach JP. The role of confounding by indication'in assessing the effect of quality of care on disease outcomes in general practice: results of a case-control study. BMC Health Serv Res. 2005;5(1):10.CrossRefPubMedPubMedCentral
14.
van Hateren KJJ, Drion I, Kleefstra N, Groenier KH, Houweling ST, van der Meer K, et al. A prospective observational study of quality of diabetes care in a shared care setting: trends and age differences (ZODIAC-19). BMJ Open. 2012;2:4.
15.
De Grauw WJC, Van de Lisdonk EH, Hoogen HJM, Van Weel C. Cardiovascular morbidity and mortality in type 2 diabetic patients: a 22-year historical cohort study in Dutch general practice. Diabet Med. 1995;12(2):117–22.CrossRefPubMed
16.
Stone MA, Charpentier G, Doggen K, Kuss O, Lindblad U, Kellner C, Nolan J, Pazderska A, Rutten G, Trento M: Quality of care of people with type 2 diabetes in eight european countries findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes Care 2013.
17.
Ackermann RT, Thompson TJ, Selby JV, Safford MM, Stevens M, Brown AF, et al. Is the number of documented diabetes process-of-care indicators associated with cardiometabolic risk factor levels, patient satisfaction, or self-rated quality of diabetes care? The Translating Research into Action for Diabetes (TRIAD) study. Diabetes Care. 2006;29(9):2108–13.CrossRefPubMed
18.
Sidorenkov G, Haaijer-Ruskamp FM, de Zeeuw D, Bilo H, Denig P. Review: relation between quality-of-care indicators for diabetes and patient outcomes: a systematic literature review. Med Care Res Rev. 2011;68(3):263–89.CrossRefPubMed
19.
National Institute for Health and Care Excellence: Diabetes in adults quality standard. In. London; 2011.
20.
Nagy E, Watine J, Bunting PS, Onody R, Oosterhuis WP, Rogic D, et al. Do guidelines for the diagnosis and monitoring of diabetes mellitus fulfill the criteria of evidence-based guideline development? Clin Chem. 2008;54(11):1872–82.CrossRefPubMed
21.
Dirks M, Niessen LW, Wijngaarden J, Koudstaal PJ, Franke CL, Oostenbrugge RJ, et al. The effectiveness of thrombolysis with intravenous alteplase for acute ischemic stroke in daily practice. Int J Stroke. 2012;7(4):289–92.CrossRefPubMed
22.
Hoeks SE, Scholte op Reimer WJM, Lingsma HF, van Gestel Y, van Urk H, Bax JJ, et al. Process of care partly explains the variation in mortality between hospitals after peripheral vascular surgery. Eur J Vasc Endovasc Surg. 2010;40(2):147–54.CrossRefPubMed
23.
Kolfschoten NE, Gooiker GA, Bastiaannet E, van Leersum NJ, van de Velde CJH, Eddes EH, et al. Combining process indicators to evaluate quality of care for surgical patients with colorectal cancer: are scores consistent with short-term outcome? BMJ Qual Saf. 2012;21(6):481–9.CrossRefPubMed
24.
Shaneyfelt TM, Mayo-Smith MF, Rothwangl J. Are guidelines following guidelines? JAMA. 1999;281(20):1900–5.CrossRefPubMed
25.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud P-AC, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65.CrossRefPubMed
26.
Rutten GEHM, De Grauw WJC, Nijpels G, Houweling ST, Van de Laar FA, Bilo HJ, et al. Diabetes guideline of the Dutch College of General Practitioners (NHG-Standaard Diabetes mellitus type 2 (derde herziening)). Huisarts Wet. 2013;56(10):512–25.
27.
Dutch Health Care Inspectorate (Inspectie voor de Gezondheidszorg). Implementation care standard Diabetes after four years of insufficient progress (Implementatie zorgstandaard Diabetes na vier jaar onvoldoende gevorderd). Utrecht: Ministry of Health, Welfare and Sport; 2012.
28.
Steinsbekk A, Rygg L, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: a systematic review with meta-analysis. BMC Health Serv Res. 2012;12(1):213.CrossRefPubMedPubMedCentral
29.
De Jong-van Til JT, Lemmens LC, Baan CA, Struijs JN. The Organization of Care Groups in 2011 (De organisatie van zorggroepen anno 2011). Bilthoven (NL): National Institute for Public Health and the Environment (RIVM); 2012.
30.
de Bakker DH, Struijs JN, Baan CA, Raams J, de Wildt J-E, Vrijhoef HJM, et al. Early results from adoption of bundled payment for diabetes care in the Netherlands show improvement in care coordination. Health Aff. 2012;31(2):426–33.CrossRef
Metadata
Title
Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study
Authors
Sandra F Oude Wesselink
Hester F Lingsma
Paul BM Robben
Johan P Mackenbach
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-014-0669-z

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Evolutionary concept analysis of health seeking behavior in nursing: a systematic review

Correspondence

Roundtable discussion on the Third Global Symposium on Health Systems Research: why prioritise talk over aid in the midst of the Ebola crisis?

Research article

The economic burden of overseas medical treatment: a cross sectional study of Maldivian medical travelers

Research article

Why do older people with multi-morbidity experience unplanned hospital admissions from the community: a root cause analysis

Research article

Social and economic costs and health-related quality of life in non-institutionalised patients with cystic fibrosis in the United Kingdom

Research article

Who pays for home care? A study of nationally representative data on disabled older Americans