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R. Sipilä et al.
Table I. Guideline implementation tools (GItools) developed during the project. All included rehabilitation-related themes
Number of
tools developed
GItool Description of the tool
Patient summary
Slide presentation
Video
Diagram
Clinical pathway
Podcasts
Other web materials A plain language short version of the guideline
A set of slides that can be used by healthcare professionals to learn and to educate others
Short lectures or demonstration of rehabilitation methods
Interactive or plain flow charts on diagnostics, treatment or rehabilitation
Flow charts on treatment and rehabilitation pathways. Does not include work tasks of different professionals
Podcasts on clinician or patient summaries
Information for patients and their carers, self-management support, influence of the disease according to ICF
framework
Descriptions of recommended performance measures
Performance measures
22
ICF: International Classification of Functioning, Disability and Health.
were surveyed with a questionnaire. The new patient summary
model was tested in a workshop with civic organizations. Based
on the literature, questionnaire results and workshop, self-care
and rehabilitation were set as permanent subtopics for the patient
versions. Self-care was emphasized in particular.
As part of the project evaluation a web survey was compiled
for the CC website users. The aim was to gather opinions on and
experiences of the GItools. The survey was open for 6 weeks
from late 2017 to early 2018. It was sent to rehabilitation seminar
participants and linked to the CC website to be viewed by users
of the site. The survey questions were rated on the Likert scale
from 1 (negative) to 5 (positive).
Implementation of seamless care pathways
15
15
9
6
5
3
44
This article describes in detail a project that was carried out
with an organizational partner. The project was launched in June
2016 in Päijät-Häme, a district with a population of 213,000
inhabitants. The rehabilitation unit operates in both primary
and specialized healthcare. Implementation of the Current Care
guideline on the shoulder tendon disorders was selected because
there was interest in integrating the rehabilitation system at
every primary healthcare centre in the area and to strengthen the
care pathway according to the recently published CC Guideline.
First, a co-operation agreement was settled on in June 2016
by the delegates from the Finnish Medical Society Duodecim
and from the administration of Päijät-Häme primary healthcare,
specialized healthcare, and the rehabilitation unit. One follow-up
meeting was organized (November 2016). A group consisting
of 6 professionals from the health district and a facilitator from
CC (RS) was set up to plan the implementation project.
The implementation plan was developed during 3 workshops
facilitated by RS. Methods such as brainstorming, discussion,
snowballing, prioritizing and short lectures were used. First, the
objectives for change were identified, prioritized and categorized.
In the second phase, the target groups for each aim, barriers to and
facilitators of change, as well as possible means (interventions) to
drive change, were identified. In the third phase, interventions were
selected, areas of responsibility and roles were designated, and
schedule was decided. If you prefer finalized, it is suitable for us.
RESULTS
GItools and educational activities
During the project, 22 rehabilitation-related new or
updated guidelines were published. For 20 of these, an
implementation plan was recorded. Various web mate-
rials, as well as patient summaries, slide presentations
and videos including rehabilitation-related materials,
were developed and published (Table I).
The GItools comprised evaluation of rehabilita-
tion needs and methods, including medical as well
as vocational rehabilitation. Many of them included
information on the ability to function and ability to
work, psychosocial treatment and psychotherapies,
non-pharmacological treatment, patient self-care gui-
dance, as well as lifestyle changes. Some GItools
included information on rehabilitation plans, therapeu-
tic exercises, the different roles of healthcare profes-
sionals, group coaching on coping with disability and
rehabilitation organizers.
Among the 50 responses to the questionnaire, these
GItools were perceived to be quite good for facilitating
guideline implementation (mean 3.6–4.1 on a scale
from 1 to 5 for various GItools). Furthermore, it was
perceived that the GItools should be included in the
Table II. Healthcare professionals’ perceived usefulness of certain GItools and view as to whether the GItool should be produced in the
future (Likert scale 1 (negative) – 5 (positive)). Number of answers 50
Does the tool facilitate implementation Should these GItools be included in the
of the guideline? Mean value
guidelines? Mean value
Interactive flow chart
Clinical pathway
Flow chart
Performance measure
Slide presentation
Information for patients and carers
Patient summary
Disease-specific ICF framework table
Video
ICF: International Classification of Functioning, Disability and Health.
www.medicaljournals.se/jrm
3.6
3.8
3.7
3.5
3.8
4.1
3.9
3.5
3.5
4.0
4.0
3.9
3.9
4.0
4.4
4.3
3.8
3.8