Implementation of guidelines in primary health care. A challenge for the municipal health centres in Finland

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Abstract
Objective - To assess the implementation of guidelines in Finnish primary health care units. Design - A semi-quantitative analysis of a cross-sectional interview survey. Setting - All municipal health centres in a selected region in Finland. Subjects - Head physicians and head nurses of the 31 participating units. Main outcome measures - 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 partici pation 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.