The use of clinical guidelines for asthma, diabetes, and hypertension in primary health care

Abstract

Objective. To investigate which clinical guidelines primary health care staff refer to regarding asthma, diabetes, and hypertension, the number of existing guidelines, and the organizational level at which they were drawn up, and whether there are different guidelines for the same disease, either in different primary health care centres or within individual centres. Design. The study is descriptive. Data were obtained by telephone interviews and by procuring clinical guidelines regarding asthma, diabetes, and hypertension from primary health care centres. Setting. Forty-one primary health care centres in one county in southeastern Sweden. Study participants. General practitioners and registered nurses in primary health care. Results. The telephone interviews showed that the staff referred to several guidelines covering each of the three diseases and these guidelines had been drawn up at five different organizational levels. The length of the clinical guidelines varied from 1 to 257 pages, and the number of guidelines for each disease ranged between 1 and 5. Conclusion. It was found that there were several documents covering the same disease that primary care staff referred to as ‘guidelines’, and that the length of the guidelines varied and they had been drawn up at different levels. A finding with possible serious consequences was that an old version of an asthma guideline was used in all primary health care centres in the study.