Implementation of guidelines in primary health care. A challenge for the municipal health centres in Finland.
OBJECTIVE
To assess the implementation of guidelines in Finnish primary health care units.


METHODS
A semi-quantitative analysis of a cross-sectional interview survey.


METHODS
All municipal health centres in a selected region in Finland.


METHODS
Head physicians and head nurses of the 31 participating units.


METHODS
Number of guidelines adopted; methods used in the implementation; and the unit's estimated purposefulness in the implementation of guidelines.


RESULTS
All health centres had adopted at least one guideline in the defined task areas, but only one-third of the units had implemented several guidelines. The implementation methods utilised were usually directive and passive rather than co-operative and problem-solving. Half of the units used training and methods involving active participation of the personnel, and in one-third a multiprofessional approach was applied. Clients' representatives were hardly ever involved in the adaptation of guidelines. A quarter of the health centres were assessed as purposeful in their policy to implement guidelines, the large units being more goal-oriented than the smaller ones.


CONCLUSIONS
A minority of health centres are goal-oriented in the adoption of guidelines and use versatile methods to support the implementation; this presents an important managerial challenge for national health care development in Finland.
Miilunpalo
S
S
UKK Institute for Health Promotion Research, Tampere, Finland. seppo.miilunpalo@uta.fi
Toropainen
E
E
Moisio
P
P
D003430:Cross-Sectional Studies; D005387:Finland; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006773:Hospitals, Municipal / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D019037:Urban Health Services / Q000592:standards*