Asthma Programme in Finland: high consensus between general practitioners and pulmonologists on the contents of an asthma referral letter.

AIMS: The purpose of the present study was to define quality criteria for an asthma referral letter using a national co-operative effort between general practitioners and pulmonologists. METHODS: A consensus-seeking expert panel representing primary and secondary health care merged evidence from the literature and existing national and local asthma programmes to produce 19 provisional criteria to be included in an asthma referral letter. These criteria were contained within a national questionnaire review which was sent out to groups of Finnish physicians. The target groups for the review were all chief pulmonologists in specialist care (n = 32), and representatives of all Finnish health centres (n = 283) - either the chief physician (n = 143) or the local asthma co-ordinating physician (n = 140). RESULTS: The overall response rate to the national questionnaire study was 75%. The three groups of responding physicians had very similar gradings on the necessity of the 19 provisional criteria, most of which were considered very necessary. 14 final disease-specific criteria for an asthma referral letter were derived as a result of this study. CONCLUSION: The main result of this study is an agreed data set of essential information that needs to be included in an asthma referral letter. Importantly these criteria were developed by general practitioners and pulmonologists together.

The quality of spirometric examinations in Finland: results from a national questionnaire survey.

National treatment programmes for asthma and chronic obstructive pulmonary disease (COPD) have in the past few years increased the need for spirometry in Finland. The purpose of this study was to determine, by means of a national questionnaire survey, the quality and number of spirometric examinations performed in Finland in 1998, the year when the national COPD programme was initiated. We estimated that 395 000-425 000 spirometric examinations were performed in Finland in 1998. The mean quality of spirometry was evaluated as moderate, and the quality index developed for this study indicated an average of scores of 67 (max 100), ranging between 43 and 88 in the whole country. The most common qualitative insufficiencies in spirometric examinations were found in preparation of the subject for the examination, performance of the examination, recognition of a successful spirometric curve and evaluation of reproducibility of the examination. Furthermore, the time reserved in the reports for performing the examination was often very short. However, in comparison with the previous questionnaire survey in Finland (in 1990), the quality of spirometry had markedly improved.

Community action against cardiovascular disease in Finland

Because of the common occurrence of heart disease and stroke in North Karelia, Finland, the people organized a petition demanding action against cardiovascular disease. A community-based programme of health education and promotion led to a significant improvement, and the experiences gained are being used as the basis for a national programme of the same kind