title: British Columbian Healthcare Providers' Perspectives on Facilitators and Barriers to Adhering to Pediatric Diabetes Treatment Guidelines.
abstract: OBJECTIVE
  There are few studies exploring why adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes is suboptimal. Our objective was to describe healthcare providers' perspectives on the facilitators of and barriers to adhering to pediatric diabetes treatment guidelines.
  
  
  METHODS
  We fielded an electronic survey to 260 pediatric diabetes healthcare providers (physicians, nurses, dietitians) in British Columbia, Canada, followed by qualitative interviews with a purposeful sample (N=15) of physicians and allied healthcare providers. Descriptive statistics and directed content analysis were used.
  
  
  RESULTS
  We received 95 of 260 survey responses(37%). Of the 260 healthcare providers who received the survey, 116 were known to be working in a pediatric diabetes centre, and 71 of 116 (61%) responded. Almost all providers were aware of (92%) and familiar with (77%) the Canadian Diabetes Association clinical practice guidelines, and most were in agreement with the recommendations. Patient-level factors, such as poor adherence and patient/family preferences for higher glycemic targets, as well as inadequate resources (i.e. funding, mental health support), were identified as significant barriers. Qualitative interviews identified 3 key themes: 1) working collectively provincially; 2) supporting emotional and mental health and 3) frequent interactions with patients. A provincial health delivery and communication model, as well as mental health support integrated into routine patient care, were recommended.
  
  
  CONCLUSIONS
  The results of this study can guide resource allocation toward key priorities, such as increased investment in mental health support for children with diabetes. The next steps include collecting patient and family perspectives on improving guideline adherence.
authors.affiliation: Department of Public Health and Health Sciences, University of Michigan-Flint, Michigan, United States.
authors.forename: Bonnie
authors.initials: B
authors.lastname: McIntosh
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Karine
authors.initials: K
authors.lastname: Khatchadourian
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: samed@cw.bc.ca.
authors.forename: Shazhan
authors.initials: S
authors.lastname: Amed
mesh_terms: D001955:British Columbia; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care
keywords: adherence; adhésion; amélioration de la qualité; clinical practice guidelines; diabète de type 1 de l'enfant; healthcare delivery; lignes directrices de pratique clinique; pediatric type 1 diabetes; prestation de soins de santé; quality improvement