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Open Access Research article

Implementing guidelines for follow-up after surgery with ventilation tube in the tympanic membrane in Norway: a retrospective study

Bjarne Austad1*, Irene Hetlevik2, Vegard Bugten3, Siri Wennberg4, Anita Helene Olsen4 and Anne-Sofie Helvik5

Author Affiliations

1 General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway and Sjøsiden Medical Centre, 7491, Trondheim, Norway

2 General Practice Research Unit, Department of Public Health and General Practice, NTNU, Trondheim, Norway

3 Department of Neuromedicine, Faculty of Medicine, NTNU, Trondheim, Norway and Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway

4 Audiological Department, Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway

5 General Practice Research Unit, Department of Public Health and General Practice, NTNU, Trondheim, Norway and Department of Ear, Nose and Throat, Head and Neck Surgery, St. Olavs Hospital, Trondheim, Norway

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BMC Ear, Nose and Throat Disorders 2013, 13:2  doi:10.1186/1472-6815-13-2

Published: 8 January 2013

Abstract

Background

When clinical guidelines are being changed a strategy is required for implementation. St. Olavs University Hospital in Norway modified their guidelines for the follow-up care of children after insertion of ventilation tubes (VT) in the tympanic membrane, transferring the controls of the healthiest children to General Practitioners (GPs). This study evaluates the implementation process in the hospital and in general practice by exploring two issues: 1) Whether the hospital discharged the patients they were supposed to and 2) whether the children consulted a GP for follow-up care.

Methods

A retrospective observational study was performed at St. Olavs University Hospital, Norway and general practice in Mid-Norway. Children under the age of 18 who underwent insertion of VT between Nov 1st 2007 and Dec 31st 2008 (n = 136) were included. Degree of guideline adherence at the hospital and in general practice was measured.

Results

The hospital adhered to the guidelines in two-thirds (68.5%) of the patients, planning more patients for follow-up by their GP than recommended in the guidelines (25.8% vs. 12.4%). All except one contacted their GP for control. In total 60% were referred back to specialist health services within two years.

Conclusions

The methods for guideline implementation were successful in securing consultations for follow-up care in general practice. Lack of guideline adherence in the hospital can partly be explained by the lack of quality of the guideline. Further studies are needed to evaluate the quality of controls done by the GPs in order to consider implications for follow-up after VT surgery.

Keywords:
Implementation; Coordination; Clinical guidelines; Primary care; General practice; Ventilation tube; Otitis media