Summary
Tuuli Nikkarinen, Santeri Huvinen, Mats Brommels. National
consensus and local consideration. Changing the prescription practices by means of
training. Evaluation Report of the ROHTO Project. Helsinki, 2002. 203p. (Reports of
the Ministry of Social Affairs and Health, ISSN 1236-2115; 2002:1)
ISBN 952-00-1111-0
The ROHTO programme is a wide-ranging action programme carried
out in 1998 to 2001 with the aim of steering physicians’ prescription practices in a
more rational direction. The project was organised by Finnish physicians’
associations, the Ministry of Social Affairs and Health, the Social Insurance Institution,
the National Agency for Medicines and the Association of Finnish Local and Regional
Authorities. The principle of the action programme was to encourage physicians to review
critically their own prescription practices. As tools were used in particular work in
small teams and workshops. In addition, extensive information activities and national
support measures were involved.
The Department of Public Health of the University of Helsinki was responsible for the
evaluation of the project. The evaluation was carried out by monitoring different modes of
action and by seeking to identify factors increasing or reducing the efficiency of the
actions. The results were reported on a regular basis, at first to the advisory group set
up for this purpose, and as the project advanced directly to the representative of the
body commissioning the evaluation study and to the project management. A progress report
on the evaluation was drawn up annually during the project.
The small-team work was organised to be carried out by regional teams. They were guided
by regional contact persons, who had been trained for this task. The participants were
predominantly satisfied, the self-steering of the teams increased the commitment and the
attitudes were moulded, but the practical results, i.e. the change in prescription
practices, were not studied in that context. The evaluation team recommends linking the
small-team work closely to the regional training organisation, which is maintained for
instance by the hospital district together with the health centres of the region. The
leaders of the small teams should be encouraged to draw up a ‘conscious model of
action’, which would facilitate self-evaluation and development of training. The work
in small teams should focus on dealing with the feedback concerning own patients and
prescription practices. The need for support to leaders should be paid enough attention.
One-day local training courses, ROHTO workshops, were organised in co-operation with
health centres. They discussed pharmacotherapy issues on the basis of the information
given by the project and local experts and by analysing the prescription statistics. This
mode of work proved a success.
The activities of the ROHTO project were visible and widely known. It was stated
unanimously that it is important to continue the activities after the project phase has
ended. In view of the ambitious objectives of the project its resources were scanty. The
worst factor limiting the achievement of the objectives was the poor access to experts and
regional contact persons. The ROHTO programme would have benefited from work that would
have taken place more clearly in the form of a project and from a closer co-operation with
health centres and hospital districts.
The evaluation team put forward a suggestion that the training concerning rational
pharmacotherapy should be made a part of the further training organised on regional basis.
It would benefit optimally individual feedback information and deal with the
participants’ own patients. Active support by the management of hospital districts
and health centres is necessary, since participation in training must be rendered possible
above all through flexible working time arrangements and without negative financial
consequences for participants. Those experts in specialties that are natural co-operation
partners of the primary health care professionals covered by the training should be used
are trainers. Local ‘peer advisors’ are needed for regional and local training
groups, and they should be provided with sufficient training and support for the work.
Key words: evaluation, development, further training, phycisians,
pharmacotherapy, prescriptions