title: Perceptions of Dutch health care professionals regarding the Care Standard for diabetes.
abstract: BACKGROUND
  The Netherlands can be regarded as unique in the use of the Netherlands Diabetes Federation (NDF) Care Standard (CS) for diabetes. The need to understand the barriers obstructing optimal health care, the dissemination and implementation of health care innovations into daily practice and the extent to which health care professionals actually adhere to guidelines has been emphasized repeatedly. Therefore, the aim of the present study was to suggest ways to optimize the implementation of the CS by examining the perceptions of Dutch health care professionals regarding the CS and the barriers to using it.
  
  
  METHODS
  A cross-sectional questionnaire survey was conducted among health care professionals (N = 1547) in 2010.
  
  
  RESULTS
  A total of 39.6% (N = 1323) of the participating health care professionals possessed the CS. Only 15.5% of the professionals who were to some extent familiar with the CS (N = 1100) described themselves as working in complete accordance with the CS. The majority (83.9%) thought the CS contributed greatly to ensuring the quality of care; the judgment on the feasibility of working in accordance with the CS was positive (mean = 3.9 on a 5-point Likert scale). However, professionals tended to perceive the guidelines issued by the own professional association as the norm for high quality diabetes care, rather than the CS. The main barrier to using the CS was the lack of effective lifestyle interventions (or access to them) to provide care for people with diabetes or those at increased risk for the disorder.
  
  
  CONCLUSIONS
  A limited percentage of health care professionals were found to posses the CS. It is questionable whether possession of the CS is a prerequisite for delivering high quality care. Overall, professionals were largely positive about the CS, although only a minority indicated they were working in complete accordance with it. Professionals and professional organizations should be further educated about the content of the CS and especially its added value with respect to the guidelines for their own professional group, in terms of the multidisciplinary approach to diabetes care. Furthermore, attention should be given to the most important perceived barriers, to facilitate adherence to the CS.
authors.affiliation: Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. lieke.raaijmakers@maastrichtuniversity.nl.
authors.forename: Lieke G M
authors.initials: LG
authors.lastname: Raaijmakers
authors.forename: Marloes K
authors.initials: MK
authors.lastname: Martens
authors.forename: Charlotte
authors.initials: C
authors.lastname: Bagchus
authors.forename: Nanne K
authors.initials: NK
authors.lastname: de Vries
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000941:ethics / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010465:Perception; D017410:Practice Guidelines as Topic; D059039:Standard of Care; D011795:Surveys and Questionnaires