Department of Psychiatry and Psychotherapy of Technische Universität München, School of Medicine, Ismaninger Str.22, 81675, Munich, Germany.
kbo-Isar-Amper-Klinikum, Academic Teaching Hospital LMU Munich, Munich-Haar, Germany.
BMC Psychiatry. 2020 Apr 19;20(1):177. doi: 10.1186/s12888-020-02504-4.
Patients with mental illnesses often have massive difficulties returning to work after inpatient treatment at a psychiatric clinic and are often at risk of losing their jobs. The psychosocial support for this patient group at the interface of clinic/outpatient care is often insufficient.
METHODS/DESIGN: The RETURN-study prospectively assesses and surveys 200 patients with mental disorders in a cluster randomized intervention study, i.e. treatment teams and patients from intervention wards receive a return-to-work (RTW) intervention. Patients in control wards obtain treatment as usual (TAU). Pairs of comparable wards (similar patient population, similar staff density) have been identified and then randomized for control and intervention (n = 14 for each condition). On intervention wards return-to-work experts (RTW experts) who focus treatment on the workplace-related needs of patients with mental illnesses have been established. These RTW experts ensure the use of available resources within the framework of work-related discharge management and should lead to a more successful return to the workplace. The days at work in the year after release will be evaluated in a mixed methods approach as well as the return rate in the year after release, disability days in the year after return, relapse rate after 12 months, cost-benefit ratio of the intervention, analysis of the predictors / barriers for a successful return to the workplace (e.g. psychopathology, cognition, stigma, social-psychiatric support, company support, etc.), possibilities to implement the concept of RTW experts in standard psychiatric care (TAU - treatment as usual), the impact of the RTW experts' approach on the treatment process in standard psychiatric care.
This approach is already internationally established in the field of somatic rehabilitation and supported employment [Am J Psychiatry 171:1183-90, 2014; Lancet 370:1146-52, 2007; Cochrane Database Syst Rev, doi:10.1002/14651858.CD006237.pub3, 2014]; the innovative aspect of this project is to implement and evaluate it in standard psychiatric care in Germany. This project requires no new interventions to be developed and tested, as the techniques of the case manager/job coach is applied to the field of return to work.
The study was registered in Deutsches Register Klinische Studien searchable via its Meta-registry (http://apps.who.int/trialsearch/), Trial registration number: DRKS00016037, Date of registration: 21/12/2018, URL of trial registry record.
精神疾病患者在精神病诊所住院治疗后重返工作岗位往往面临巨大困难，经常有失业风险。诊所/门诊护理中这一患者群体的社会心理支持往往不足。
方法/设计：RETURN 研究前瞻性评估和调查 200 名精神障碍患者，采用集群随机干预研究，即治疗团队和干预病房的患者接受重返工作（RTW）干预。对照病房的患者接受常规治疗（TAU）。已确定并随机分配了类似的病房（相似的患者人群、相似的员工密度）进行对照和干预（每组 14 个条件）。在干预病房，专注于精神疾病患者与工作相关需求的重返工作专家（RTW 专家）已经建立。这些 RTW 专家确保在与工作相关的出院管理框架内利用现有资源，并应导致更成功地重返工作岗位。将采用混合方法评估出院后一年内的工作天数，以及出院后一年内的返岗率、返岗后一年内的残疾天数、12 个月后的复发率、干预的成本效益比、对成功返岗的预测因素/障碍的分析（例如精神病理学、认知、耻辱感、社会精神病学支持、公司支持等）、在标准精神科护理中实施 RTW 专家概念的可能性（TAU-常规治疗）、RTW 专家方法对标准精神科护理治疗过程的影响。
这种方法在躯体康复和支持性就业领域在国际上已经得到确立[美国精神病学杂志 171:1183-90, 2014；柳叶刀 370:1146-52, 2007；Cochrane 数据库系统综述，doi:10.1002/14651858.CD006237.pub3, 2014]；该项目的创新之处在于在德国标准精神科护理中实施和评估它。该项目不需要开发和测试新的干预措施，因为病例经理/工作教练的技术适用于重返工作领域。
该研究已在德国注册，可通过其元注册在德国临床研究注册中心（Deutsches Register Klinische Studien）中搜索（http://apps.who.int/trialsearch/），试验注册号：DRKS00016037，注册日期：2018 年 12 月 21 日，试验注册网址。
