Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, Tilburg 5000 LE, The Netherlands.
BMC Public Health. 2013 Mar 6;13:193. doi: 10.1186/1471-2458-13-193.
Sickness absence due to common mental disorders (such as depression, anxiety disorder, adjustment disorder) is a problem in many Western countries. Long-term sickness absence leads to substantial societal and financial costs. In workers with common mental disorders, sickness absence costs are much higher than medical costs. In the Netherlands, a practice guideline was developed that promotes an activating approach of the occupational physician to establish faster return-to-work by enhancing the problem-solving capacity of workers, especially in relation to their work environment. Studies on this guideline indicate a promising association between guideline adherence and a shortened sick leave duration, but also minimal adherence to the guideline by occupational physicians. Therefore, this study evaluates the effect of guideline-based care on the full return-to-work of workers who are sick listed due to common mental disorders.
METHODS/DESIGN: This is a two-armed cluster-randomised controlled trial with randomisation at the occupational physician level. During one year, occupational physicians in the intervention group receive innovative training to improve their guideline-based care whereas occupational physicians in the control group provide care as usual. A total of 232 workers, sick listed due to common mental disorders and counselled by participating occupational physicians, will be included. Data are collected via the registration system of the occupational health service, and by questionnaires at baseline and at 3, 6 and 12 months. The primary outcome is time to full return-to-work. Secondary outcomes are partial return-to-work, total number of sick leave days, symptoms, and workability. Personal and work characteristics are the prognostic measures. Additional measures are coping, self-efficacy, remoralization, personal experiences, satisfaction with consultations with the occupational physician and with contact with the supervisor, experiences and behaviour of the supervisor, and the extent of guideline adherence.
If the results show that guideline-based care in fact leads to faster and sustainable return-to-work, this study will contribute to lowering personal, societal and financial costs.
ISRCTN86605310.
由于常见精神障碍（如抑郁症、焦虑症、适应障碍）导致的缺勤是许多西方国家的一个问题。长期缺勤会导致巨大的社会和经济成本。在患有常见精神障碍的工人中，缺勤成本远高于医疗成本。在荷兰，制定了一项实践指南，提倡职业医生采取积极的方法，通过增强工人解决问题的能力（特别是与工作环境相关的能力），更快地重返工作岗位。该指南的研究表明，遵循指南与缩短病假期限之间存在有希望的关联，但职业医生对该指南的遵循度也很低。因此，本研究评估基于指南的护理对因常见精神障碍而请病假的工人全面重返工作岗位的效果。
方法/设计：这是一项两臂集群随机对照试验，以职业医生为单位进行随机分组。在一年期间，干预组的职业医生接受创新培训，以改善其基于指南的护理，而对照组的职业医生则提供常规护理。共有 232 名因常见精神障碍而请病假并接受参与职业医生咨询的工人将被纳入研究。数据通过职业健康服务的登记系统以及基线和 3、6 和 12 个月时的问卷调查收集。主要结局是完全重返工作岗位的时间。次要结局是部分重返工作岗位、总病假天数、症状和工作能力。个人和工作特征是预后指标。其他措施包括应对方式、自我效能感、重新激励、个人经历、对与职业医生咨询和与主管接触的满意度、主管的经历和行为以及遵循指南的程度。
如果结果表明基于指南的护理确实能更快且可持续地重返工作岗位，本研究将有助于降低个人、社会和经济成本。
ISRCTN86605310。
