gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Guideline adherence in the Netherlands: a systematic review

Meeting Abstract

  • P. Mistiaen - NIVEL, Utrecht, Netherlands
  • E. Bloemendal - NIVEL, Utrecht, Netherlands
  • W. Jan Willem - IQ healthcare, Nijmegen, Netherlnds
  • H. Mirjam - IQ healthcare, Nijmegen, Netherlnds

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO57

doi: 10.3205/12gin089, urn:nbn:de:0183-12gin0898

Veröffentlicht: 10. Juli 2012

© 2012 Mistiaen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: Guidelines are important decision resources. However, the extent of (Dutch) guideline-adherence, what influential factors are and if better adherence leads to better outcomes are unclear.

Objectives: To investigate the adherence rate to Dutch guidelines, influential factors to and effects of it.

Methods: A systematic review was performed in 6 literature-databases (2000-2011) for empirical studies on the adherence to Dutch guidelines. Included studies were categorized according to research design, professional group, healthcare setting and guideline subject. Methodological study quality was assessed with EPOC-instruments.

Results: 8677 unique references were obtained, of which 100 documents (91 studies) were included. Studies concerned guidelines for physicians (76), nurses (19) and physiotherapists (13), working in hospital (51), primary (43) or residential (6) care. The majority (76) were observational studies, and 5 were RCTs. Adherence rate was operationalized in many ways. Consequently, a large variation in adherence was found, making an overarching statement impossible. A moderate indication was found that adherence is positively related with a positive attitude of professionals towards guidelines, practical usefulness of the guideline, level of evidence of guideline recommendations, a form of automated support in using the guideline and combined methods of implementing the guideline. Effects of adherence were found in a few studies and tended to show better patient outcomes, but were inconclusive about cost (effectiveness).

Discussion: Adherence to Dutch guidelines varies widely. Due to measuring differences, we cannot provide a general statement about guideline adherence.

Implications for guideline developers/users: A more uniform system to measure adherence is needed.