New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Trials. 2020 Mar 12;21(1):256. doi: 10.1186/s13063-020-4168-8.
Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers through preventing illnesses that cause work disability and early retirement. However, impacting on the trajectory between illness and work disability requires continuity of care and follow up, enabled through identifying patients at risk. We aimed to determine whether a combined educational and electronic reminder system in occupational health care could improve the recording and follow up of primary care visits made by patients at risk of work disability, and whether the system could impact on sickness absence rates.
This study is a pragmatic, cluster-randomized controlled trial using medical record data. Twenty-two Pihlajalinna Työterveys units were randomized into an intervention group receiving education and electronic reminders or a group receiving usual care through minimization methods. Patient consultation data were extracted from routine Pihlajalinna Työterveys patient registers from 2015 to 2017. In addition, process indicators were collected from the electronic system. Data were cleaned and analysed on an intention-to-treat basis using analysis of covariance.
There was no significant difference between intervention and control units in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians' practice of recording patients' risk of work disability and work-relatedness of visits following the educational intervention.
Education with an electronic reminder can change physicians' practice, but long-term follow up is needed to determine whether this impacts on patients' sickness absences.
ISRCTN Registry: ISRCTN45728263. Registered on 12 April 2016.
在欧洲老龄化人口中，延长工作生涯是一个关键的政策目标，但实现这一目标很复杂。职业健康服务处于通过预防导致工作残疾和提前退休的疾病来延长工作生涯的最佳位置。然而，要影响疾病和工作残疾之间的轨迹，需要连续性的护理和跟进，这可以通过识别有患病风险的患者来实现。我们旨在确定职业保健中结合教育和电子提醒系统是否可以改善有工作残疾风险的患者的初级保健就诊记录和随访情况，以及该系统是否可以影响病假率。
这是一项实用的、基于群组的随机对照试验，使用医疗记录数据。22 个 Pihlajalinna Työterveys 单位通过最小化方法随机分为接受教育和电子提醒的干预组或接受常规护理的对照组。从 2015 年到 2017 年，从常规的 Pihlajalinna Työterveys 患者登记处提取患者咨询数据。此外，还从电子系统中收集了过程指标。使用协方差分析对基于意向治疗的清洁和分析数据进行了分析。
在不同持续时间的病假方面，干预组和对照组之间没有显著差异。过程指标表明，在接受教育干预后，医生记录患者工作残疾风险和就诊与工作相关性的做法发生了变化。
教育加电子提醒可以改变医生的做法，但需要长期随访才能确定这是否会影响患者的病假。
ISRCTN 注册表：ISRCTN45728263。于 2016 年 4 月 12 日注册。
