title: The implementation of national action program diabetes in the Netherlands: lessons learned.
abstract: BACKGROUND
  Over the past decade, the National Action program Diabetes (NAD) was implemented in the Netherlands. Its aim was to introduce the Care Standard (CS) for diabetes by means of a specific implementation plan and piloting in several regions. This study aimed to provide insight into the implementation of the NAD as, coupled with the introduction of the CS, it may function as an example for similar approaches in other countries.
  
  
  METHODS
  A series of quantitative studies (participants 2010: N = 1726, participants 2013: N = 1370 & participants pilot regions 2013: N = 168) and qualitative studies (participants 2010: N = 18 and participants 2013: N = 4) was conducted among health care professionals (HCPs). In addition, two quantitative studies were conducted among type 1 and 2 patients (participants 2010: N = 573; participants 2013: N = 5056).
  
  
  RESULTS
  Overall, positive changes in diabetes care were detected in the period 2010 - 2013. In 2013 significantly more HCPs were familiar with the CS (43.7 versus 37.6 %) and more HCPs perceived themselves to be working largely or completely in accordance with the CS (89.2 versus 79.0 %) than in 2010. A comparison of the results in specific pilot regions with the rest of the country revealed that HCPs in these regions scored significantly more positively on implementation and appreciation of the CS. This positive trend was reflected by the high levels of reported patient satisfaction and involvement in treatment. HCPs who were in possession of the CS had significantly better scores on the implementation of several elements of the CS than HCPs who were not in possession of the CS.
  
  
  CONCLUSIONS
  The CS has become more prominent and embedded in daily health care practice. In retrospect the CS has provided momentum for the realization of various processes relating to the wider implementation of standards to improve the care for people with other chronic diseases in the Netherlands. Experiences with the NAD and CS underline the need to move towards an integrated multidisciplinary approach of diabetes care worldwide.
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.affiliation: Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. s.kremers@maastrichtuniversity.nl.
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
authors.affiliation: Department of Internal Medicine, CAPHRI School for Primary Care and Public Health, Maastricht University Medical Centre+, Maastricht, The Netherlands. n.schaper@mumc.nl.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: Netherlands Diabetes Federation, Amersfoort, The Netherlands. i.deweerdt@diabetesfederatie.nl.
authors.forename: Inge
authors.initials: I
authors.lastname: de Weerdt
authors.affiliation: ResCon, Research & Consultancy, Haarlem, The Netherlands. m.martens@rescon.nl.
authors.forename: Marloes K
authors.initials: MK
authors.lastname: Martens
authors.affiliation: ResCon, Research & Consultancy, Haarlem, The Netherlands. a.hesselink@rescon.nl.
authors.forename: Arlette E
authors.initials: AE
authors.lastname: Hesselink
authors.affiliation: Department of Health Promotion, CAPHRI School for Primary Care and Public Health, Maastricht University Medical Centre+, Maastricht, The Netherlands. n.devries@maastrichtuniversity.nl.
authors.forename: Nanne K
authors.initials: NK
authors.lastname: de Vries
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006078:Government Programs; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007858:Learning; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D010865:Pilot Projects; D016730:Program Development; D036301:Qualitative Research