Barriers to guideline-compliant XXXX care: analyses and concepts.

@entity1 @entity1569 @entity146
UNASSIGNED: Despite the availability of effective therapeutics and evidence-based treatment guidelines, a substantial proportion of @entity1 with moderate-to-severe @entity1569 does not receive appropriate care. This under-provision of health care may cause further worsening of health, remarkable limitations of the @entity1 's quality of life, and indirect costs for the health care system. In order to provide guideline-compliant care for every @entity1569 @entity1 , it is important to identify barriers obstructing optimal care. Studies have identified various barriers on the physician's and on the @entity1 's side; however, respective studies approached only single barriers, and not all of them in the context of @entity1569 . Other publications that describe barriers systematically did not focus on @entity1569 either. The objective of this literature review was to identify barriers and facilitators, based on studies analysing quality of care and single barriers, resulting in a comprehensive model of causal factors. Our analyses revealed three categories of barriers - @entity1 -related, physician-related and external factors: On the @entity1 side, we found non-adherence to therapies to be an important barrier, often in close association with @entity146 factors. Barriers on the physician's side predominantly are incomplete knowledge of the guidelines as well as the complexity of @entity1569 comorbidity. In some countries, payment for @entity1 with complex disease status is poor and inconsistent reimbursement regulations potentially interfere with optimal care. The current analysis indicates that most barriers are interdependent. Thus, measures approaching related barriers simultaneously are required. To improve care for @entity1569 @entity1 , further studies systematically addressing all potentially relevant barriers in conjoint are needed.
