Evaluation of hypertension guideline implementation in Finnish health centres

1
Evaluation of hypertension guideline
implementation in Finnish health centres

• Seija Alanen, MNSc
• Riitta Johannala-Kemppainen, MNSc
• Jarja Ijäs, MD
• Minna Kaila, PhD
• Matti Klockars, MD
• Marjukka Mäkelä, PhD
• Maritta Välimäki, PhD

2
Background

• Evidence-based clinical guidelines,
• the Current Care Guidelines, have been published
  since 1997 in Finland.
• They have been widely disseminated,
• and are well accepted and considered useful
  among health professionals.
• Only few studies conducted to evaluate the
  implementation and impact of guidelines in
  Finland.

3
Aims of this study

• To describe the extent of adoption and the style
  of implementation of the Hypertension Guideline
  in Finnish health centres
• To identify health centres representing opposite
  styles in implementation (guideline disseminators
  and implementers)

4
Data collection 1/3

• A computer-assisted telephone interview was
  conducted in October-November 2004
• All head physicians and head nurses in Finnish
  health centres 577 participants from 290 health
  centres (3 centres only employed a head physician)

5
Data collection 2/3

• The questionnaire
• Developed by our research team
• Intended to serve the needs of ECCE project
  (Evaluation of Current Care Effectiveness)

6
Data collection 3/3

• Criteria for the style of implementation -
  sum-score
• Organisational (maximum points from criterion)
• Adoption of a guideline (2)
• Participation in guideline development (2)
• Updating the guideline (1)
• Professional
• 4. Informing professionals
• 5. Informing teams (1)
• 6. Familiarisation of staff (1)
• 7. Staff training (1)
• Patient
• 8. Informing patients (1)
• 9. Informing population (1)

7

Results
8
Respondents
9
Organisational criteria met
10
Professional criteria met
11
Patient criteria met
12
Variations in implementation style 1/2
13
Variations in implementation style 2/2

• Health centres having values 0 - 2 were
  classified as disseminators (N 23),
• and those having values 10 11 as implementers
  (N 21)
• Implementers had larger population base, and
  services were based on the personal physician
  system
• Shortage of staff was not connected to
  implementation style

14
Conclusion

• HT Guideline has been adopted in clinical
  practice in most Finnish health centres
• The style of implementation varies widely

15
Further studies

• Has the implementation style
• had impact on professional practices and patient
  care?