Barriers to implementing the clinical guideline on borderline personality disorder in the Netherlands.
OBJECTIVE
This study determined the gap between actual care and optimal care (recommended in the clinical guideline) for patients with borderline personality disorder in the Netherlands. Factors that affected guideline implementation were identified.


METHODS
Ten specialized mental health organizations participated in this cross-sectional study. The number and proportion of patients who received optimal diagnosis and treatment were calculated. Focus groups explored implementation barriers.


RESULTS
Records of 422 patients with a diagnosis of borderline personality disorder were analyzed, and 315 records from six organizations contained the necessary data. Across the six organizations, most of these patients received this as an initial diagnosis (median 85%). However, only a minority received psychotherapy as a first-step treatment (median 23%). Capacity problems and organizational barriers were the main barriers to providing psychotherapy.


CONCLUSIONS
Most patients with borderline personality disorder did not receive the recommended first-step treatment (psychotherapy). Care pathways may help improve efficiency and quality of care.
Innovation of Mental Health Care Program, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands. mhermens@trimbos.nl
Marleen L M
ML
Hermens
Peter T
PT
van Splunteren
Annemiek
A
van den Bosch
Roel
R
Verheul
D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000458:organization & administration*