Finland

Current Care – from evidence into practice

Current Care Guidelines are produced for the benefit of Finnish health care. Guidelines are developed on topics which affect public health, when a variety of clinical practices are used and when recent findings require urgent implementation.

The Current Care Editorial Office is part of Duodecim, the Finnish Medical Society. This is a scientific society which enhances the professional skills and clinical practices of physicians, through further education, publications and research grants. Duodecim has 91 member organisations and its 19,000 members include over 90% of Finnish doctors and medical students (www.duodecim.fi).

Guidelines are produced using the top Finnish experts in their respective fields. So far, over 700 health care professionals have contributed to this work, most of them doctors. The Current Care organisation is the Finnish centre for evidence-based medicine.

Uniform, high-quality treatment based on current knowledge

Current Care guidelines are based on accurate, reliable and up-to-date information which has been systematically evaluated and compiled by clinical experts in the relevant field. These guidelines play a significant role in Finnish health care. National recommendations provide a solid basis for the development of regional treatment protocols and chains. Furthermore, the Current Care guidelines were used as the starting point when uniform criteria for access to non-emergency care were considered and later verified by the Ministry of Social Affairs and Health.

Up-to-date information for the benefit of patients

As medicine is a rapidly advancing field, the guidelines are updated by their respective working groups every few years - or whenever required by advancements in the field – in order to keep the treatment of patients up to date at all times. Online publication guarantees the availability and dissemination of up-to-date information. In addition to being published in the Duodecim Medical Journal, Current Care guidelines, together with their abstracts and patient versions, are published online at www.kaypahoito.fi, via the Duodecim health portal “TERVEYSPORTTI”. The patient versions are also available from Duodecim’s health library at www.terveyskirjasto.fi.

FINOHTA

FINOHTA is an independent, publicly funded health technology assessment agency. It produces, supports and co-ordinates health technology assessments in Finland and disseminates international assessment results within the health care system. FINOHTA’s goal is to enhance the effectiveness and impact of health care by supporting decision-making and promoting the use of proper evidence-based methods.

In addition to assessing established methods for diagnosis, treatment and rehabilitation, FINOHTA also evaluates new methods. The Managed Uptake of Medical Methods program (MUMM) produces quick assessments of emerging technologies, especially those of major importance to public health or national economy. Assessment research is carried out in multidisciplinary collaboration.

FINOHTA is a founding member of G-I-N and actively involved in organising the G-I-N conference in October 2008 in Helsinki. FINOHTA is also a member of other international networks such as INAHTA, EUnetHTA and EuroScan. The Finnish Branch of the Nordic Cochrane Centre is located in FINOHTA.

Co-operation with the Finnish Medical Society, Duodecim, and its Current Care organisation is active and complementary. FINOHTA assesses the cost-effectiveness of selected Current Care guidelines; most recently, on treatment of high blood pressure and screening for glaucoma.

FINOHTA was founded in 1995 and is part of STAKES, the National Research and Development Centre for Welfare and Health. Over forty people work for FINOHTA - some full-time and some part-time - equivalent to around 25 person years in total.

Duodecim Medical Publications Ltd.

Duodecim Medical Publications Ltd. (DMP) is the largest medical publisher in Scandinavia with 40 employees, more than 2,000 authors, and about 150 headings covering most medical specialities. The company is fully owned by the 126-year-old Finnish Medical Society Duodecim, a scientific society of all Finnish physicians. DMP has been working since 1988 to produce evidence-based guidelines (EBM guidelines, http://ebmg.wiley.com/) in electronic format. The database now contains 1,000 concise guidelines intended mostly for primary and ambulatory care, and 3,500 evidence summaries that are linked to Cochrane reviews and other evidence sources. EBM guidelines has been translated into seven languages.

In 2001, DMP launched the Finnish health portal (www.terveysportti.fi) that has become the most frequently used source of knowledge for Finnish health care professionals. More than three million documents and more than a million guidelines are opened every month, including the national Current Care guidelines that are accessed through the portal.

The citizens’ health portal (www.terveyskirjasto.fi) is based on the guidelines and evidence produced by Duodecim. There are about 5.3 million Finns and they open three million documents a month through this portal.

Evidence in to action

Recently, Duodecim has developed EBMeDS (Evidence-Based Medicine electronic Decision Support, www.kaypahoito.fi/decisionsupport/decisionsupport.htm) as a clinical decision support tool for bringing evidence to the attention of clinicians and consumers as they are making their decisions about the best options for a particular situation. The patient’s age and gender, the diagnoses that have been made, the medication used, the test results available, and the procedures planned, all contribute to the selection of relevant evidence and to formulating recommendations that are fit to the patient at the current clinical context. EBMeDS is an open-source software tool and database that has been designed as a simple and flexible solution for linking context-sensitive evidence and guidance with any software application dealing with structured patient data, such as electronic health records (EHR), order entry systems (CPOE), consumers’ personal health records (PHR) etc. The reminders generated by EBMeDS can be shown during patient encounters or use of a PHR at the point of care, they can be listed for a group of patients (a “virtual health check”) as a tool for disease management and quality assessment of a defined population, or they can be triggered for virtual patients in interactive educational tools.

The Centre for Pharmacotherapy Development ROHTO

ROHTO has been an expert unit under the Ministry of Social Affairs and Health since 2003.

The aim of ROHTO is to promote the health of the Finnish population by:

• collecting and disseminating information to promote rational pharmacotherapy and
• supporting the implementation of this into practice.

Knowledge into action

To promote more rational pharmacotherapy, ROHTO

• evaluates, summarises and disseminates information on evidence-based, cost-effective pharmacotherapy
• implements knowledge
• monitors, describes and studies prescription practices and conveys benchmarking data

ROHTO has built up a national network of trained implementers (usually GPs), who run interprofessional, interactive workshops using national clinical guidelines and other evidence-based material. The prescribers, particularly in primary health care, are the target group of their activities. The main focus of their activities is the implementation of knowledge promoting rational pharmacotherapy using local educational and development activities.