Brouwers Evelien P M, de Bruijne Martine C, Terluin Berend, Tiemens Bea G, Verhaak Peter F M
Netherlands Institute for Health Services Research (NIVEL) Utrecht, the Netherlands.
Eur J Public Health. 2007 Apr;17(2):214-20. doi: 10.1093/eurpub/ckl099. Epub 2006 Jul 12.
Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders.
In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later.
Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group.
Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.
病假缺勤在情绪困扰或轻度精神障碍患者中经常出现。在几个欧洲国家，这些患者在领取疾病津贴的人群中占比过高，因此需要采取干预措施。本研究的目的是评估一项由社会工作者实施的干预措施的成本效益，该干预措施旨在减少因情绪困扰或轻度精神障碍而缺勤的患者的病假时长。
在这项随机对照试验中，患者由全科医生招募。干预组（N = 98）接受社会工作者提供的积极、结构化治疗，对照组（N = 96）接受常规全科医生护理。在基线以及3、6和18个月后测量病假时长、临床症状和医疗消耗（医务人员时间消耗以及药物消耗）。
两组之间在病假时长和随时间的临床改善方面均未发现显著差异。干预组的相关成本也没有显著降低。
与常规全科医生护理相比，积极的社会工作干预在减少病假时长、改善临床症状和降低医疗消耗方面并不优越。在治疗轻度精神障碍方面，与全科医生常规护理相比，它也不具有成本效益。因此，进一步实施该干预措施是不合理的。潜在地，在更接近工作场所开展的旨在减少轻度精神障碍患者病假时长的项目（例如由职业医生开展）可能比初级保健项目更成功。
