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Asthma programme in Finland: comparison of adult asthma referral letters in 1994 and 2001.

https://arctichealth.org/en/permalink/ahliterature168015
Source
Respir Med. 2007 Mar;101(3):595-600
Publication Type
Article
Date
Mar-2007
Author
Leena E Tuomisto
Minna Kaila
Marina Erhola
Author Affiliation
Seinajoki Central Hospital, Hanneksenrinne 7, 60220 Seinäjoki, Finland. leena.tuomisto@epshp.fi
Source
Respir Med. 2007 Mar;101(3):595-600
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Asthma - epidemiology
Correspondence as Topic
Female
Finland - epidemiology
Humans
Male
Middle Aged
Program Evaluation - methods
Quality of Health Care
Referral and Consultation - standards
Abstract
The aim of the study was to evaluate the quality of asthma-related referral letters at the launch of the Asthma Programme in 1994 and 7 years later in 2001.
All referrals during 1 year (n=1121 in 1994, n=1136 in 2001) to one pulmonary department were screened in 2001. By the same inclusion criteria of asthma or suspicion of asthma, 624 letters (56% of all) from the year 1994 and 452 (40% of all) from the year 2001 were selected. The quality of study letters was assessed against the previously developed asthma referral letter criteria. Comparison of the referral letter quality in 1994 and 2001 was made.
The proportion of poor letters decreased from 63% in 1994 to 44% in 2001, while that of good letters increased from 7% to 22%. Graphics of peak flow follow-up measurements (14% vs. 40%) and spirometry with bronchodilatation test (5% vs. 32%) were included significantly more often as an attachment.
Lung functions are being measured more often in primary care, indication a more active detection of asthma. The number of asthma-related referrals in relation to all pulmonary consultation referrals decreased and their quality improved during the years of the Asthma Programme.
PubMed ID
16890421 View in PubMed
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Asthma Programme in Finland: the quality of primary care spirometry is good.

https://arctichealth.org/en/permalink/ahliterature154909
Source
Prim Care Respir J. 2008 Dec;17(4):226-31
Publication Type
Article
Date
Dec-2008
Author
Leena Tuomisto
Vesa Jarvinen
Jukka Laitinen
Marina Erhola
Minna Kaila
Pirkko Brander
Author Affiliation
Pulmonary Department, Seinajoki Central Hospital, Seinajoki, Finland. leena.tuomisto@gmail.com
Source
Prim Care Respir J. 2008 Dec;17(4):226-31
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Asthma - diagnosis - physiopathology - therapy
Female
Finland
Forced Expiratory Flow Rates - physiology
Forced Expiratory Volume - physiology
Humans
Male
Medical Audit
Middle Aged
Primary Health Care
Program Evaluation
Referral and Consultation
Reproducibility of Results
Retrospective Studies
Spirometry
Young Adult
Abstract
To assess the quality of primary care spirometry by visual inspection of the flow-volume expiratory curve and to study the quantity of clinical information provided on the spirometry report sheets.
Retrospective audit of 868 expiratory flow-volume curves referred to three pulmonary clinics assessed against five predefined quality criteria. Clinical information included on the spirometry report sheets was also collected.
Quality was good in 78% of pre-bronchodilation curves and in 80% of post-bronchodilation curves. Obtaining a sharp PEF value and full vital capacity exhalation seemed to be the critical points of measurement. Inter-rater reliability of the curve assessment was mainly good. Data on where the spirometry took place, and comments on the use of respiratory medication and patient co-operation were often lacking.
The quality of primary care spirometry was good. Adequate clinical information on the report sheets would further improve the quality of this diagnostic process.
Notes
Comment In: Prim Care Respir J. 2009 Sep;18(3):231-2; author reply 23219662322
Erratum In: Prim Care Respir J. 2009 Sep;18(3):184
PubMed ID
18830519 View in PubMed
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Cost-effectiveness analysis of guidelines for antihypertensive care in Finland.

https://arctichealth.org/en/permalink/ahliterature160632
Source
BMC Health Serv Res. 2007;7:172
Publication Type
Article
Date
2007
Author
Neill Booth
Antti Jula
Pasi Aronen
Minna Kaila
Timo Klaukka
Katriina Kukkonen-Harjula
Antti Reunanen
Pekka Rissanen
Harri Sintonen
Marjukka Mäkelä
Author Affiliation
Tampere School of Public Health, University of Tampere, Tampere, Finland. neill.booth@uta.fi
Source
BMC Health Serv Res. 2007;7:172
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Antihypertensive Agents - economics - therapeutic use
Cost-Benefit Analysis
Decision Making
Drug Administration Schedule
Drug Utilization - economics - standards
Female
Finland - epidemiology
Guideline Adherence - economics
Humans
Hypertension - drug therapy - economics - epidemiology
Male
Middle Aged
Practice Guidelines as Topic
Quality-Adjusted Life Years
Registries
Abstract
Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).
A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.
The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.
The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.
Notes
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PubMed ID
17958883 View in PubMed
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Hypertension guideline implementation: experiences of Finnish primary care nurses.

https://arctichealth.org/en/permalink/ahliterature157305
Source
J Eval Clin Pract. 2008 Oct;14(5):830-5
Publication Type
Article
Date
Oct-2008
Author
Seija Alanen
Jarja Ijäs
Minna Kaila
Marjukka Mäkelä
Maritta Välimäki
Author Affiliation
Tampere University Hospital, Tampere, Finland. seija.alanen@pshp.fi
Source
J Eval Clin Pract. 2008 Oct;14(5):830-5
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Ambulatory Care - organization & administration
Attitude of Health Personnel
Chi-Square Distribution
Diffusion of Innovation
Evidence-Based Practice - education - organization & administration
Female
Finland
Humans
Hypertension - prevention & control
Information Dissemination
Male
Middle Aged
Nurse's Role - psychology
Nursing Methodology Research
Nursing Staff - education - organization & administration - psychology
Organizational Innovation
Patient Education as Topic
Practice Guidelines as Topic
Primary Health Care - organization & administration
Questionnaires
Workload - psychology
Abstract
Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses.
We assessed the style of implementation and adoption of the national Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors.
Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion that the HT Guideline has been adopted into clinical practice. The recommendations in the HT Guideline were adopted in clinical practice with varying success, and slightly more often in implementer health centres than in disseminator health centres. Nurses in implementer health centres more often agreed that multiple channels had been used in the implementation (P
PubMed ID
18462289 View in PubMed
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Maternal and perinatal characteristics and the risk of cow's milk allergy in infants up to 2 years of age: a case-control study nested in the Finnish population.

https://arctichealth.org/en/permalink/ahliterature143535
Source
Am J Epidemiol. 2010 Jun 15;171(12):1310-6
Publication Type
Article
Date
Jun-15-2010
Author
Johanna Metsälä
Annamari Lundqvist
Minna Kaila
Mika Gissler
Timo Klaukka
Suvi M Virtanen
Author Affiliation
Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland. johanna.metsala@thl.fi
Source
Am J Epidemiol. 2010 Jun 15;171(12):1310-6
Date
Jun-15-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Animals
Case-Control Studies
Cattle
Cesarean Section - statistics & numerical data
Confidence Intervals
Female
Finland - epidemiology
Food Hypersensitivity - epidemiology - etiology
Gestational Age
Humans
Infant
Logistic Models
Male
Maternal Age
Middle Aged
Milk - immunology
Mothers - statistics & numerical data
Odds Ratio
Parity
Pregnancy
Pregnancy, Multiple - statistics & numerical data
Risk factors
Sex Factors
Smoking - adverse effects
Socioeconomic Factors
Young Adult
Abstract
This study examined whether maternal background and perinatal factors were associated with the risk of cow's milk allergy (CMA) in infants up to 2 years of age in a nested case-control study. All children born in 1996-2004 in Finland and diagnosed with CMA by 2006 were identified (n = 16,237). For each case, one matched control was selected. Information on maternal and perinatal factors was derived from the Medical Birth Register. The associations were analyzed by conditional logistic regression. Cesarean section (adjusted odds ratio (OR) = 1.18, 95% confidence interval (CI): 1.10, 1.27) and high maternal age (> or =35 years; adjusted OR = 1.23, 95% CI: 1.11, 1.36) were associated with increased risk, whereas low maternal socioeconomic status (adjusted OR = 0.65, 95% CI: 0.59, 0.71), smoking (adjusted OR = 0.72, 95% CI: 0.67, 0.79), high number of previous deliveries (> or =5; adjusted OR = 0.71, 95% CI: 0.59, 0.86), and multiple pregnancy (adjusted OR = 0.70, 95% CI: 0.60, 0.82) were associated with decreased risk of CMA. In conclusion, maternal background and perinatal factors may play a role in the development of CMA, but further research is needed to clarify these associations and the underpinning biologic mechanisms.
PubMed ID
20472571 View in PubMed
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Patient-specific computer-based decision support in primary healthcare--a randomized trial.

https://arctichealth.org/en/permalink/ahliterature256870
Source
Implement Sci. 2014;9:15
Publication Type
Article
Date
2014
Author
Tiina Kortteisto
Jani Raitanen
Jorma Komulainen
Ilkka Kunnamo
Marjukka Mäkelä
Pekka Rissanen
Minna Kaila
Author Affiliation
School of Health Sciences, University of Tampere, Tampere, Finland. tiina.kortteisto@uta.fi.
Source
Implement Sci. 2014;9:15
Date
2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Decision Support Systems, Clinical - organization & administration
Electronic Health Records - organization & administration
Female
Finland
Humans
Information Systems - organization & administration
Male
Middle Aged
Primary Health Care - organization & administration
Quality of Health Care - organization & administration
Reminder Systems
Young Adult
Abstract
Computer-based decision support systems are a promising method for incorporating research evidence into clinical practice. However, evidence is still scant on how such information technology solutions work in primary healthcare when support is provided across many health problems. In Finland, we designed a trial where a set of evidence-based, patient-specific reminders was introduced into the local Electronic Patient Record (EPR) system. The aim was to measure the effects of such reminders on patient care. The hypothesis was that the total number of triggered reminders would decrease in the intervention group compared with the control group, indicating an improvement in patient care.
From July 2009 to October 2010 all the patients of one health center were randomized to an intervention or a control group. The intervention consisted of patient-specific reminders concerning 59 different health conditions triggered when the healthcare professional (HCP) opened and used the EPR. In the intervention group, the triggered reminders were shown to the HCP; in the control group, the triggered reminders were not shown. The primary outcome measure was the change in the number of reminders triggered over 12 months. We developed a unique data gathering method, the Repeated Study Virtual Health Check (RSVHC), and used Generalized Estimation Equations (GEE) for analysing the incidence rate ratio, which is a measure of the relative difference in percentage change in the numbers of reminders triggered in the intervention group and the control group.
In total, 13,588 participants were randomized and included. Contrary to our expectation, the total number of reminders triggered increased in both the intervention and the control groups. The primary outcome measure did not show a significant difference between the groups. However, with the inclusion of patients followed up over only six months, the total number of reminders increased significantly less in the intervention group than in the control group when the confounding factors (age, gender, number of diagnoses and medications) were controlled for.
Computerized, tailored reminders in primary care did not decrease during the 12 months of follow-up time after the introduction of a patient-specific decision support system.
ClinicalTrial.gov NCT00915304.
Notes
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PubMed ID
24444113 View in PubMed
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Primary care guidelines: Senior executives' views on changing health centre practices in hypertension treatment.

https://arctichealth.org/en/permalink/ahliterature147241
Source
Scand J Prim Health Care. 2009;27(4):202-7
Publication Type
Article
Date
2009
Author
Jarja Ijäs
Seija Alanen
Minna Kaila
Eeva Ketola
Solja Nyberg
Maritta A Välimäki
Marjukka Mäkelä
Author Affiliation
Health Centre of the City of Järvenpää
Source
Scand J Prim Health Care. 2009;27(4):202-7
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Antihypertensive Agents - therapeutic use
Attitude of Health Personnel
Community Health Centers
Family Practice
Finland
Guideline Adherence
Humans
Hypertension - diagnosis - drug therapy
Middle Aged
Nursing, Supervisory
Physician Executives
Practice Guidelines as Topic
Questionnaires
Abstract
To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres.
A cross-sectional telephone survey.
All municipal health centres in Finland.
Health centres where both the head physician and the senior nursing officer responded.
Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension Guideline.
Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p
Notes
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PubMed ID
19929184 View in PubMed
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Use of web-based patient education sessions on psychiatric wards.

https://arctichealth.org/en/permalink/ahliterature126543
Source
Int J Med Inform. 2012 Jun;81(6):424-33
Publication Type
Article
Date
Jun-2012
Author
Minna Anttila
Maritta Välimäki
Heli Hätönen
Tiina Luukkaala
Minna Kaila
Author Affiliation
Finnish Post-Graduate School in Nursing Science and University of Turku, Department of Nursing Science, Finland. minna.anttila@utu.fi
Source
Int J Med Inform. 2012 Jun;81(6):424-33
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Education, Nursing - statistics & numerical data
Female
Finland - epidemiology
Hospitals, Psychiatric - statistics & numerical data
Humans
Internet - utilization
Male
Mental Disorders - epidemiology - rehabilitation
Middle Aged
Nurses - statistics & numerical data
Patient Education as Topic - methods
Patient Satisfaction - statistics & numerical data
Prevalence
Young Adult
Abstract
To evaluate the use of web-based patient education sessions in the psychiatric inpatient care.
The qualitative and quantitative data was collected from 93 patients' evaluation reports in two psychiatric hospitals in Finland completed by 83 nurses.
The web-education included six patient education sessions which were used over a period lasting between 1 and 70 days and took 10-360 min per patient. Out of 508 sessions, 464 had no interruptions or disturbances, 37 sessions had disturbances and seven sessions were interrupted. Three fourths of the sessions were used successfully. Factors associated with use were patients' vocational education level, mental status, diagnoses, number of nurses involved and hospital.
It is important to invest effort in web-based patient education during patients' hospitalization and to use it even with patients suffering from serious mental health disorders. This is meant to provide more alternatives in nursing.
PubMed ID
22381805 View in PubMed
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What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians.

https://arctichealth.org/en/permalink/ahliterature157013
Source
Fam Pract. 2008 Jun;25(3):162-7
Publication Type
Article
Date
Jun-2008
Author
Helena Varonen
Tiina Kortteisto
Minna Kaila
Author Affiliation
Department of General Practice and Primary Care, University of Helsinki, Helsinki. helena.varonen@helsinki.fi
Source
Fam Pract. 2008 Jun;25(3):162-7
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Computers
Decision Support Systems, Clinical
Diffusion of Innovation
Female
Finland
Focus Groups
Humans
Interviews as Topic
Male
Middle Aged
Physicians
Abstract
To identify potential barriers and facilitators to implementing computerized decision support systems (CDSSs) in health care as perceived by clinicians.
We carried out a qualitative focus group study with primary and secondary health care settings in six areas of Finland. A total of 39 interviewed physicians, of whom 22 practised in primary care and 17 in secondary care. The main outcome measures physicians' expectations, preconceived barriers and facilitators were explicitly identified by the participants during the interviews.
Identified barriers were earlier experience of dysfunctional computer systems in health care, potential harm to doctor-patient relationship, obscured responsibilities, threats to clinician's autonomy and potential extra workload due to excessive reminders. Identified facilitators were self-control of frequency and contents of CDSS and noticeable help of CDSS in clinical practice. It was easy for the physicians to think of applications and clinical topics for CDSS that could help them to avoid mistakes and improve work processes.
Physicians had relatively positive attitudes towards the idea of CDSS. They expected flexibility, individuality and reliability of the CDSS. The rather high level of computerized practices and wide use of electronic guidelines probably have paved the way for the CDSS in Finland.
PubMed ID
18504253 View in PubMed
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9 records – page 1 of 1.