Practice guidelines in Finland: Availability and quality

Objective-To describe the quantity, quality, and availability of practice guidelines currently used in Finland. Design-Cross sectional survey. Methods-Guidelines from 1989 to 1995 were collected through a database search, through hand searches of the two Finnish general medical journals, and through an inquiry into hospitals, health centres, and medical societies. The content and source of evidence for guidelines was assessed. Results-719 practice guidelines were found. 578 guidelines (80%) were retrieved by the inquiry, the database search identified 27 (4%) and hand searches 106 (15%). There were 150 guidelines (21%) developed nationally, 120 (17%) regionally, and 449 (62%) locally. The structure and quality of evidence supporting the guidelines was variable and only two guidelines were based on meta-analysis. The references were significantly more often (P<0.001) documented in the national guidelines (n=129, 86%) than in the regional or local guidelines (n=65, 11%). Conclusions-There are many ways of disseminating guidelines and it may be difficult for end users to find the appropriate guidelines. Sources of evidence were seldom documented in the regional and local guidelines and even some national guidelines lacked all references. More attention should be paid to documenting the level of evidence, structuring the guidelines, and creating optimal strategies for development and dissemination of guidelines.