Buijs Peter C, van Dijk Frank J H, Evers Marÿe, vd Klink Jacques J L, Anema Han
Toegepast Natuurwetenschappelijk Onderzoek: Applied Scientific Research, Work and Employment, Hoofddorp, The Netherlands.
Ind Health. 2007 Jan;45(1):37-43. doi: 10.2486/indhealth.45.37.
Increasingly, workers have psychological work-related complaints, endangering their work ability and causing considerable economic losses. Many employees consult their general practitioner (GP). He, however, often pays insufficient attention to work-relatedness or to coordination with occupational physicians (OPs). Appropriate guidelines are missing. Consequently, we developed a GP guideline to handle these problems in coordination with OPs, and tested it in a pilot, using an explorative, evaluative study design. 23 GPs were trained to include employed patients and to test the guideline. Patients received questionnaires after 0, 4, 10 and 30 wk, GPs after 4 and 30 wk. The result was a new guideline, regarding problem orientation, diagnosis and advice, meant to avoid contradictory GP-OP advice and to activate patient responsibility. It included a GP-OP-patient communication form concerning information exchange and harmonization of insight/advice. Implementing GPs concluded that the guideline promotes recovery and work resumption and OP-GP contact benefits patients, prevents conflicting advice and promotes agreement on task division. They judged guideline efficiency and OP commitment less positively. Patients were positive, especially about GP-OP contact. Accordingly, an improved guideline, when tested for its effectiveness in a Randomized Controlled Trial, can help GPs to cope with a growing, complex problem, in collaboration with their occupational colleagues.
越来越多的工人出现与工作相关的心理问题，这危及他们的工作能力并造成相当大的经济损失。许多员工会咨询他们的全科医生（GP）。然而，全科医生往往对与工作的相关性或与职业医生（OP）的协调关注不足。目前缺少适当的指导方针。因此，我们制定了一项全科医生指导方针，以便与职业医生协调处理这些问题，并采用探索性、评估性研究设计在一项试点中对其进行测试。23名全科医生接受了培训，将受雇患者纳入其中并测试该指导方针。患者在0周、4周、10周和30周后收到问卷，全科医生在4周和30周后收到问卷。结果形成了一项关于问题导向、诊断和建议的新指导方针，旨在避免全科医生和职业医生的建议相互矛盾，并激发患者的责任感。它包括一份关于信息交流以及见解/建议协调的全科医生 - 职业医生 - 患者沟通表格。参与实施的全科医生得出结论，该指导方针促进康复和恢复工作，职业医生与全科医生的联系对患者有益，可防止相互矛盾的建议，并促进在任务分工上达成一致。他们对指导方针的效率和职业医生的投入评价没那么积极。患者则持积极态度，尤其是对全科医生与职业医生的联系。因此，一项经过改进的指导方针，在随机对照试验中测试其有效性时，可帮助全科医生与职业同事协作应对日益复杂的问题。
