Table 3 Health care region-specific challenges and strengths during implementation process

ESSOTE

A simultaneous extensive organizational change (fusion of primary and secondary health care organizations, including relocation of primary care facilities)

Research nurses and the principal investigator can remind/educate professionals of the new protocol from time to time.

During the re-evaluation, additional education lessons will take place in units during

• emergency duty nurses’ meeting 2x60min

• student health care unit nurses’ meeting 1x90min

• junior physicians’ meeting 1x75min

• GPs’ meeting 1x60min

• general medicine department nurses’ meeting 2x30min

• PTs’ meeting 2x30min

• occupational health physicians’ meeting

• PTs’ meeting 1x60min

The nurse in charge of the emergency room is active in improving the implementation of the new care strategy.

Rovaniemi

Low GP participation rate in education.

Emergency department not part of the study.

Simultaneous relocation of primary health care facilities.

No occupational health service organization included the study.

Previously complicated wide criteria for direct access to PT enormously reduces the possibility to use it. A notable criterion for direct access to physiotherapy during implementation process might be helpful.

EKSOTE

Simultaneous change in electronic medical record system increases requirements to adopt new working practices among professionals.

Some biopsychosocial oriented education for PTs had been held before this study, which is helpful for implementation.

Mentoring will be arranged for PTs during implementation and re-evaluation.