title: Implementing guidelines for follow-up after surgery with ventilation tube in the tympanic membrane in Norway: a retrospective study.
abstract: BACKGROUND
  When clinical guidelines are being changed a strategy is required for implementation. St. Olavs University Hospital in Norway modified their guidelines for the follow-up care of children after insertion of ventilation tubes (VT) in the tympanic membrane, transferring the controls of the healthiest children to General Practitioners (GPs). This study evaluates the implementation process in the hospital and in general practice by exploring two issues: 1) Whether the hospital discharged the patients they were supposed to and 2) whether the children consulted a GP for follow-up care.
  
  
  METHODS
  A retrospective observational study was performed at St. Olavs University Hospital, Norway and general practice in Mid-Norway. Children under the age of 18 who underwent insertion of VT between Nov 1st 2007 and Dec 31st 2008 (n = 136) were included. Degree of guideline adherence at the hospital and in general practice was measured.
  
  
  RESULTS
  The hospital adhered to the guidelines in two-thirds (68.5%) of the patients, planning more patients for follow-up by their GP than recommended in the guidelines (25.8% vs. 12.4%). All except one contacted their GP for control. In total 60% were referred back to specialist health services within two years.
  
  
  CONCLUSIONS
  The methods for guideline implementation were successful in securing consultations for follow-up care in general practice. Lack of guideline adherence in the hospital can partly be explained by the lack of quality of the guideline. Further studies are needed to evaluate the quality of controls done by the GPs in order to consider implications for follow-up after VT surgery.
authors.affiliation: General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway and Sjøsiden Medical Centre, 7491, Trondheim, Norway. bjarne.austad@ntnu.no.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Austad
authors.forename: Irene
authors.initials: I
authors.lastname: Hetlevik
authors.forename: Vegard
authors.initials: V
authors.lastname: Bugten
authors.forename: Siri
authors.initials: S
authors.lastname: Wennberg
authors.forename: Anita Helene
authors.initials: AH
authors.lastname: Olsen
authors.forename: Anne-Sofie
authors.initials: AS
authors.lastname: Helvik