title: Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study.
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.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Oude Wesselink
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: Paul B M
authors.initials: PB
authors.lastname: Robben
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010361:Patients / Q000523:psychology*