Evidence in action--guidelines directing workload

Abstract

Objective: To approximate the workload of blood pressure (BP) measurements and lifestyle counselling in primary healthcare when the related guidelines are followed. To evaluate the impact of facilitated guideline implementation with respect to workloads.

Design: Modelling study after cross-sectional audit process.

Setting: Thirty-one municipal health stations. Intervention Intrinsic facilitation in implementation of hypertension guideline.

Main outcome measures: Number and level (normal <140/85 mmHg, slightly 140-160/85-95 mmHg or markedly elevated >160/95 mmHg) of BP measurements at nurses' appointments, approximation of time allocated for measurements and lifestyle counselling before and 1 year after the intervention.

Results: A total of 3119 BP measurements were recorded during the audit week in 2002. BP level measurements were "normal" in 1214 (38.9%), slightly elevated in 1371 (44.0%) and markedly elevated in 534 (17.1%). According to the modelling, 12% of a nurse's workday consisted of BP recordings and counselling. After intervention, the corresponding figures were 2330 measurements (828 (35.5%) normal, 990 (42.5%) slightly and 512 (22.0%) markedly elevated) corresponding to 6.3% of the workday.

Conclusions: Through facilitation programmes, it is possible to change working practices according to the related guidelines, agree on the division of tasks and empower patients to engage with their own treatment. These changes can lead to considerable decreases in the workload of health centre personnel with consequent redistribution of personnel resources to patients in true need for services.