Department of Primary and Community Care, Gender and Women's Health, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
BMC Fam Pract. 2019 Mar 2;20(1):38. doi: 10.1186/s12875-019-0924-9.
Assessing the cost effectiveness of training aimed at increasing general practitioners' (GP) work awareness and patients' work-related self-efficacy and quality of life.
A cluster randomized controlled trial in twenty-six GP practices in the southeast of the Netherlands with 32 participating GPs. GPs working in an intervention group practice received training and GPs working in a control group practice delivered usual care. The training intervention consisted of lectures and workshops aimed at increasing GPs' work awareness and more proactive counseling for patients with work-related problems (WRP). Subjects were working age patients with paid work for at least 12 h per week, who visited one of the participating GPs during the study period. As outcome measures we used the Return to Work Self Efficacy scale to assess patients' work-related self-efficacy and the Euroquol to assess quality of life. We also measured health care costs and productivity costs. With a 4-item questionnaire we asked patients to assess their GPs' work awareness. Data were collected at baseline, after 6 and 12 months.
Data of 280 patients could be analyzed. The patient related outcomes did not improve after GP training. The change in GP work awareness and the overall mean cost difference (of €770) in favor of the intervention group were not significant.
The training intervention presented in this paper was not cost-effective. Training which is further personalized and targeted at high risk groups with respect to WRP, is more likely to be cost effective.
评估旨在提高全科医生（GP）工作意识、患者工作相关自我效能感和生活质量的培训的成本效益。
在荷兰东南部的 26 家全科诊所进行了一项集群随机对照试验，共有 32 名参与的全科医生。在干预组实践中工作的全科医生接受培训，而在对照组实践中工作的全科医生提供常规护理。培训干预包括旨在提高全科医生工作意识和更积极主动地为有工作相关问题（WRP）的患者提供咨询的讲座和研讨会。研究对象为每周至少有 12 小时有偿工作的工作年龄患者，他们在研究期间访问了参与的全科医生之一。我们使用“重返工作自我效能感量表”来评估患者的工作相关自我效能感，使用“Euroqol”来评估生活质量。我们还测量了医疗保健成本和生产力成本。通过 4 项问卷调查患者对其 GP 的工作意识的评估。在基线、6 个月和 12 个月时收集数据。
对 280 名患者的数据进行了分析。GP 培训后患者相关结局没有改善。GP 工作意识的变化和有利于干预组的总体平均成本差异（€770）并不显著。
本文介绍的培训干预措施不具有成本效益。进一步个性化和针对 WRP 高危人群的培训更有可能具有成本效益。
