title: Family doctors' assessment of patient- and health care system-related factors contributing to non-adherence to diabetes mellitus guidelines.
abstract: OBJECTIVE
  The aim of this study was to assess family doctors' opinions on the patient- and health care system-related factors contributing to non-adherence to diabetes mellitus clinical practice guidelines (CPG) in Estonia.
  
  
  METHODS
  Descriptive postal survey using a self-administered questionnaire.
  
  
  RESULTS
  Of the 354 doctors who received the questionnaire 46% (n=163) responded. Seventy-six percent of them have type 2 diabetes guidelines. Low awareness of diabetes and its complications as well as patients' low motivation to change their lifestyle were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems non-compliance with medical regimen, patients' financial problems and their nonattendance were mentioned. The greatest health care system-related barriers to practices providing desirable care were the lack of special diabetes education for nurses and underfunding, and an inadequate number of patients' educational materials. The patient-related issues were regarded as problems in 96% of the cases and health care system-related factors were mentioned in 79% of the cases.
  
  
  CONCLUSIONS
  Family doctors in Estonia consider patient-related factors to be key issues in non-adherence to diabetes mellitus clinical practice guidelines.
authors.affiliation: Department of Polyclinic and Family Medicine, University of Tartu, Estonia. anneli.ratsep@ut.ee
authors.forename: A
authors.initials: A
authors.lastname: Rätsep
authors.forename: I
authors.initials: I
authors.lastname: Oja
authors.forename: R
authors.initials: R
authors.lastname: Kalda
authors.forename: M
authors.initials: M
authors.lastname: Lember
mesh_terms: D003376:Counseling; D003920:Diabetes Mellitus / Q000628:therapy*; D004957:Estonia; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires