a Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands.
b Department of Primary and Community Care, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands.
Eur J Gen Pract. 2018 Dec;24(1):258-265. doi: 10.1080/13814788.2018.1517153.
Paying attention to their patients' work and recognizing work-related problems is challenging for many general practitioners (GPs).
To assess the effect of training designed to improve the care for patients with work-related problems in general practice.
A cluster randomized controlled trial among 32 Dutch GPs. GPs in the intervention group received five-hour training. GPs in the control group were not trained. Included patients (age 18-63, working ≥12 h per week) completed baseline questionnaires and follow-up questionnaires planned after one year. Primary outcome at patient level was patients' expectations about their ability to work, measured using the return-to-work self-efficacy scale (RTW-SE). Primary outcomes on GP level were their use of ICPC-code Z05 ('work-related problem') per 1000 working-age patients and percentage of the electronic medical files of working-age patients in which information about occupation had been recorded.
A total of 640 patients completed the baseline questionnaire and 281 the follow-up questionnaire. We found no statistically significant differences in patients' RTW-SE scores: intervention 4.6 (95%CI: 4.2-5.0); control 4.5 (95%CI: 4.1-4.9). Twenty-nine GPs provided data about the GP-level outcomes, which showed no statistically significant differences: use of ICPC code Z05 11.6 (95%CI: 4.7-18.6) versus 6.0 (95%CI: -1.2 to 13.2) per 1000 working-age patients; recording of occupation 28.8% (95%CI: 25.8-31.7) versus 28.6% (95%CI: 25.6-31.6).
Training GPs did not improve patients' work-related self-efficacy or GPs' registration of work-related problems and occupation.
关注患者的工作并识别与工作相关的问题对许多全科医生（GP）来说具有挑战性。
评估旨在改善全科医疗中与工作相关问题患者护理的培训效果。
一项针对 32 名荷兰全科医生的群组随机对照试验。干预组的全科医生接受了 5 小时的培训。对照组的全科医生未接受培训。纳入的患者（年龄 18-63 岁，每周工作≥12 小时）完成基线问卷和计划在一年后进行的随访问卷。患者层面的主要结局是使用重返工作自我效能量表（RTW-SE）衡量患者对自己工作能力的期望。医生层面的主要结局是每位 1000 名工作年龄患者中使用国际疾病分类临床修订版（ICPC）编码 Z05（“与工作相关的问题”）的次数和工作年龄患者电子病历中记录职业信息的百分比。
共有 640 名患者完成了基线问卷，281 名患者完成了随访问卷。我们发现患者的 RTW-SE 评分无统计学显著差异：干预组 4.6（95%CI：4.2-5.0）；对照组 4.5（95%CI：4.1-4.9）。29 名全科医生提供了医生层面结局的数据，显示无统计学显著差异：每位 1000 名工作年龄患者使用的 ICPC 编码 Z05 为 11.6（95%CI：4.7-18.6）与 6.0（95%CI：-1.2 至 13.2）；记录职业为 28.8%（95%CI：25.8-31.7）与 28.6%（95%CI：25.6-31.6）。
培训全科医生并未提高患者与工作相关的自我效能或全科医生对与工作相关问题和职业的记录。
