Schaafsma Frederieke, Hugenholtz Nathalie, de Boer Angela, Smits Paul, Hulshof Carel, van Dijk Frank
Academic Medical Center, University of Amsterdam, Department Coronel Institute of Occupational Health, Amsterdam, Netherlands.
Scand J Work Environ Health. 2007 Oct;33(5):368-78. doi: 10.5271/sjweh.1156.
This study attempted to determine the effectiveness of an intervention to enhance evidence-based advice given by occupational physicians.
Altogether 106 occupational physicians were cluster randomized into 16 groups. The intervention group received a course in evidence-based medicine, followed by a 4-month period of case-method learning sessions in peer groups once every 2 weeks. During these sessions, the participants discussed their patients with respect to sickness absence and the existing evidence for return-to-work prognosis and effective interventions. The participants were assigned to perform a literature search at least once every 4 weeks. The primary outcome measure was the quality of advice based on the correct assessment of prognosis for return to work or the correct choice of return-to-work interventions. Secondary outcome measures were the quality of the searches performed by the intervention group, the use of evidence by all occupational physicians during the intervention period, and the potential predictors for advice quality.
Better return-to-work interventions were advised by the intervention group than by the control group after 2 months (88% versus 67%, P=0.01), but the difference had decreased after 4 months (76% versus 62%, not significant). No better assessments of prognosis were found for return to work. Most of the searches had a good quality (83% or 73%), and good searching was a positive predictor for a good choice of advised interventions (P=0.03). Without obligatory searches, no increase in evidence use was found.
Evidence-based advice by occupational physicians in sickness absence episodes can be improved with multifaceted intervention. The actual search for evidence is an essential element.
本研究旨在确定一项干预措施对提高职业医师提供循证建议的有效性。
总共106名职业医师被整群随机分为16组。干预组接受循证医学课程培训，随后为期4个月，每两周在同侪小组中进行一次案例学习。在这些课程中，参与者就病假情况、复工预后的现有证据以及有效的干预措施讨论他们的患者。参与者被要求至少每4周进行一次文献检索。主要结局指标是基于对复工预后的正确评估或对复工干预措施的正确选择的建议质量。次要结局指标是干预组进行检索的质量、所有职业医师在干预期内对证据的使用情况以及建议质量的潜在预测因素。
2个月后，干预组给出的复工干预建议比对照组更好（88%对67%，P=0.01），但4个月后差异减小（76%对62%，无统计学意义）。未发现对复工预后有更好的评估。大多数检索质量良好（83%或73%），良好的检索是建议干预措施选择良好的积极预测因素（P=0.03）。在没有强制检索的情况下，未发现证据使用增加。
通过多方面干预可以改善职业医师在病假事件中提供的循证建议。实际的证据检索是一个关键要素。
