Evaluation of current care effectiveness:: A survey of hypertension guideline implementation in Finnish health centres

Objective. To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implementers or disseminators respectively). Design. A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. Setting. Primary healthcare. Subjects. All head physicians and senior nursing officers in Finnish health centres (n =290). Main outcome measures. The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. Results. Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264 health centres (91%) in Finland. The HT Guideline had been introduced into clinical practice in most health centres (89%). The style of implementation varied widely between health centres: at opposite ends of the implementation scale were 21 implementer health centres, which used multiple implementation channels, and 23 disseminator health centres, which used few or no implementation channels. The implementers had typically larger population bases and had organized services around the family doctor system, while the disseminators were smaller and had organized services according to a traditional model (appointments could be with any doctor in the surgery). Conclusion. The Finnish HT Guideline has become well known in most health centres since being introduced into clinical practice. However, the style of implementation varies markedly between health centres.