Dissemination and usage of an online compendium in four European countries Rabady, Kunnamo G-I-N Lisbon 2009 Evidence can cross borders – can guidelines do the same?

The Project Developed in Finland, disseminated internationally, translated into several languagesDeveloped in Finland, disseminated internationally, translated into several languages Adaptation and online version for German speaking countriesAdaptation and online version for German speaking countries “Point-of-care” - project“Point-of-care” - project Rabady, Kunnamo Lisbon 2009

The Aim To learn about dissemination and usage by comparison:To learn about dissemination and usage by comparison: –Same project –Different health systems –Different methods of dissemination –Different preconditions Methods:Methods: –Log files –User survey Rabady, Kunnamo Lisbon 2009

Comparing Dissemination Rabady, Kunnamo Lisbon 2009

Use of Physician´s databases in Finland Number of guidelines opened approx. 12 million/year (2009 estimated)

Comparing Usage Rabady, Kunnamo Lisbon 2009

Web-based survey May – June physicians and 500 medical students were ed a web-based (Webropol ™) questionnaire in Finland and in the German-speaking countries Response rate 18 %

Frequency of EBMG use German- speaking countries vs. Finland

Answers German-speaking countries vs. Finland

Use by time of the day and day of the week Rabady, Kunnamo Lisbon 2009 German- speaking Finland

In spite of differences in working conditionsIn spite of differences in working conditions –Number of patient contacts –Referral thresholds –Role of primary care there is little difference in the number of articles opened per user dailythere is little difference in the number of articles opened per user daily Rabady, Kunnamo Lisbon 2009

Some background for the discussion Finland provides free access for every health professional in public health systemFinland provides free access for every health professional in public health system In Finland EBMG is integrated in a Health portal with documentsIn Finland EBMG is integrated in a Health portal with documents Few German-speaking doctors are online during consultationsFew German-speaking doctors are online during consultations Rabady, Kunnamo Lisbon 2009

German-speaking countriesGerman-speaking countries –ca copies of the book sold within 3 years –Few hundred online accesses sold over two years Main source of information for physicians in FinlandMain source of information for physicians in Finland –77 % electronic databases –23 % books and journals Rabady, Kunnamo Lisbon 2009

Questions What are the reasons for variance of clinical practice in different countries? Which differences are real?What are the reasons for variance of clinical practice in different countries? Which differences are real? Which factors influence the acceptability of guidelines that have originally been produced in another country?Which factors influence the acceptability of guidelines that have originally been produced in another country? Rabady, Kunnamo Lisbon 2009

What‘s in Common? Most read articles Lyme-Borreliose1896 Antibiotikatherapie1253 Impfungen1066 Therapie beim Harnwegsinfekt1041 Halsschmerzen und Tonsillitis1010 Herpes zoster830 Tonsillitis und Pharyngitis Kind788 Tiefe Venenthrombose771 Akute Otitis beim Kind738 Diabetes mellitus: Definition, Differentialdiagnostik725 Lumbalgie725 Rabady, Kunnamo Lisbon 2009

What`s in Common - Discussion Those who have it, use it.Those who have it, use it. EbM-Guidelines are being used mainly during office hours.EbM-Guidelines are being used mainly during office hours. Frequent and typically GP - topics are frequently searched for.Frequent and typically GP - topics are frequently searched for. Rabady, Kunnamo Lisbon 2009

Conclusion „Guideline adaptation“ seems to imply the necessity to adapt dissemination methods.„Guideline adaptation“ seems to imply the necessity to adapt dissemination methods. Rabady, Kunnamo Lisbon 2009

Health Gate a comprehensive health portal in Finland Contains over documents, including e.g. e-books, medical journals, pharmaceutical databases and guidelines. Can be reached by almost all practising physicians, but also by other health care professionals Evidence-Based Medicine Guidelines (EBMG) is an essential part of ”Health gate” EBMG contains over regularly updated guidelines Main target groups are primary care and outpatient clinics Over 400 specialists participate in EBM Guidelines production

Frequency of ”Health Gate” use

Answers by age-groups below or over 50

Answers GP:s vs. other specialists

Conclusions In all groups, the impression of EBMG quality was high (over 90% considered it very good or good) Younger doctors, non-specialists and GP:s found it more useful in everyday practice There were practically no negative opinions: most answers that were not ”very good” or ”good” were in the ”cannot say” category

This all sounds good… Too good? –Can we rely on web-based questionnaire results and feedback? –How should we complement this information?

Pros of web-based questions Easy, quick and cheap to do A lot of people can be reached in a short time Can be answered and returned quickly from target group perspecti ve But

Cons of web-based questionnaires Using Internet you catch people who use Internet Too many s and questionnaires may cause frustration and select people who are willing to reply Formulating questions right you get answers you like to get (as with any questionnaire)

Web-based questions can be used to… Identify major problems Get an impression of general opinion Reach a large population and get many answers = lots of quantitative data Marketing purposes But For more precise and scientificically sound results, complementary qualitative methods should be used like e.g. –Video-taped appointments –Focus group interviews

What`s the difference? Germany has by far the lowest percentage of users, compared with Austria and SwitzerlandGermany has by far the lowest percentage of users, compared with Austria and Switzerland German doctors open more articles per user and login than any of the othersGerman doctors open more articles per user and login than any of the others Rabady, Kunnamo Lisbon 2009