title: Emerging trends in diabetes care practice and policy in The Netherlands: a key informants study.
abstract: BACKGROUND
  Effective self-management is viewed as the cornerstone of diabetes care. Many interventions and policies are available to support self-management, but challenges remain regarding reaching specific subgroups and effectively changing lifestyles. Here, our aim was to identify emerging policies and practices regarding diabetes care in The Netherlands.
  
  
  METHODS
  Study with a purposeful sample of key informants, covering a range of stakeholders. They were individually interviewed, using a flexible and semi-structured approach. A thematic analysis was done, guided by an international framework, which resulted in 28 themes.
  
  
  RESULTS
  After a decade of investing in diabetes care in The Netherlands, stakeholders seem to have shifted their focus towards a view that effective self-management is expected in most people. The expectation is that individuals' personal networks, community organizations and emerging information technologies will facilitate this. If support of self-management is required, this has to be provided by local coalitions of health and social care organizations, with involvement of municipalities. Poor reach in specific subgroups of the population, such as economically deprived people, is recognized but has not led to targeted policies.
  
  
  CONCLUSIONS
  The role of healthcare providers in supporting patients' self-management in diabetes care seems to be changing in The Netherlands.
authors.affiliation: Radboud University Medical Centre, Scientific Institute for Quality in Healthcare, P,O, Box 9101, 6500 HB Nijmegen, The Netherlands. Michel.Wensing@Radboudumc.nl.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Jan
authors.initials: J
authors.lastname: Koetsenruijter
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Portillo
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
mesh_terms: D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000639:trends*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000639:trends*; D010348:Patient Care Team / Q000639:trends; D010353:Patient Education as Topic / Q000639:trends; D011050:Policy Making; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012648:Self Care / Q000191:economics / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome