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Nordic guideline research workshop

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					Nordic guideline research workshop
22.9.2006 Copenhagen




Jarja Ijäs MD
Järvenpää Finland
Finnish national clinical practice
guidelines = Current Care

   The first graded, scientific evidenced
    based Current Care guideline was
    published in 1997
   At the moment total of 71 CC guidelines
   Targeted at primary and secondary care,
    health personnel and population
   Available via internet (www.kaypahoito.fi)
    and also special edited patient version in
    lay health magazines
Finnish national clinical practice
guidelines = Current Care

   CC guideline for hypertension was
    published in January 2002
   One of the most frequently visited
    www-site is on high blood pressure
   CC guidelines are well accepted and
    considered useful
Evaluation of Current Care
Effectiveness = ECCE

     Ecce group consists of four substudies
    I. Evaluation of implementation of
        the national guideline for high
        blood pressure
    II.  Evaluation of implementation of the national
         guideline for cardiopulmonary resuscitation
    III. Evaluation of a facilitator system in
         implementation of guidelines
    IV. Development of a general evaluation modell
         and a set of tools for the assessment of
         national guideline implementation
Hypertension
   Hypertension is chronic, one of the most
    prevalent disorder
   9,5 % of the total population is on a
    reimbursed drug treatment
   Problems in the management of
    hypertension (Kastarinen et al 2001) :
       overweight
       active non-medical treatment
       drug-treatment using drug combinations
       recording practices (CV risk factors; BMI,
        smoking and alcohol consumptions habits)
Is there a consensus on
implementation of national
guidelines for high blood pressure
among chief executives in Finnish
primary health care?
Background

   The objective of the Hypertension
    guideline (HT guideline) is to
    standardize the prevention,
    treatment and follow up of patients
    with high blood pressure.
   HT guideline is targeted at health
    personnel
   HT guideline covers diagnosis,
    treatment and follow up
Background

   HT guideline does not take a stand
    on how to arrange services or
    assign tasks among the health
    personnel
   Requisition: A local house rule
Objective
   To assess the level of agreement
    between the chief executive pair,
    head physician and head nurse, in
    the same health center,
       on work processes relevant to
        management of hypertension,
       on monitoring the treatment of
        hypertension and
       the use of health counselling according
        to HT Guideline
Method

   a cross-sectional questionnaire
    survey
   setting: primary health care in
    Finland
   data collection: computer-assisted
    telephone interview (CATI) in
    October-November 2004
   participants: head physicians and
    head nurses of all municipal health
    centers (N=290)
Table 1. Characteristics of the respondents

Characteristics                                     Profession
                                   Head                Head              All
                                 physicians            nurses
                                  N=145                N=145            N=290
Gender (%)
Female                                31                  97             64
Age, years (mean,SD)
Professional experience, years
                                 25        (7,6)     26        (7,2)
   (mean, SD)
Working years in health
                                 15        (10,3)    14        (11,2)
   center (mean, SD)
Highest education (%)
Higher university degree              97                  44             70
Lower university degree               -                   6               3
Polytechnic or nursing school         3                   50             27
     Table 2. The level of agreement between the chief
     executives concerning work processes relevant to
     management of hypertension


Questions                              Level of agreement

                           Yes   No      Yes/no   Percentage of agreement
                           (n)   (n)      (n)              (%)

Assign tasks (n=130)       55    26        49               62

Regular calibration of
                           107   2         17               87
sphygmomanometer (n=126)

Double blood pressure
                           90    4         33               74
measurement (n=127)
     Table 3. The level of agreement between the chief
     executives concerning agreements made on monitoring
     practice in the patient record


Questions                                    Level of agreement

                                 Yes   No      Yes/no   Percentage of agreement
                                 (n)   (n)      (n)              (%)

Follow up frequency in blood
                                 71    14        39               69
pressure measurement (n=124)

Target level of blood pressure
                                 46    20        56               54
(n=122)

Cardiovascular risk of patient
                                 18    45        46               58
(n=109)
     Table 4. The level of agreement between the chief
     executives concerning provided group counselling


Questions                               Level of agreement

                            Yes   No      Yes/no    Percentage of agreement
                            (n)   (n)      (n)               (%)

Smoking cessation (n=141)   69    25       48                 67


Weight loss (n=141)         118   3        20                 86


Exercise (n=142)            88    13       41                 71
Conclusions
   The majority of the chief executives
    agreed that work processes relevant to
    management of hypertension had been
    done
   The discrepancy was high in agreements
    made on monitoring practices except for
    that on registering follow up frequencies
   Chief executives were highly consisted
    with each other on providing group
    counselling
Thank you!

				
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