工作应激干预对医疗保健使用和治疗的影响与常规治疗相比：瑞典初级医疗保健中的一项随机对照试验。
Effects of a work stress intervention on healthcare use and treatment compared to treatment as usual: a randomised controlled trial in Swedish primary healthcare.
机构信息
School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMC Fam Pract. 2020 Jul 6;21(1):133. doi: 10.1186/s12875-020-01210-0.
BACKGROUND
Work stress is an increasing burden in society. Identifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care. The Work Stress Questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate whether the use of the WSQ, in combination with physicians' feedback, resulted in differences in healthcare visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU.
METHODS
A two-armed randomised controlled trial was conducted at seven primary healthcare centres (PHCCs) in Region Västra Götaland, Sweden. One group received the WSQ intervention, and the controls received TAU. Employed, not sick-listed persons aged 18-64 years who sought care for mental or physical health complaints at the PHCCs participated. Register data on healthcare visits and treatments 12 months prior to inclusion and 12 months after were obtained and analysed with Fisher's exact test together with questionnaire data (WSQ and background features).
RESULTS
A total of 271 participants were included in the study, 132 intervention and 139 controls. Visits to psychologists/psychotherapists were higher among intervention participants with high stress (20%, n = 87) during follow-up compared to corresponding controls (7%, n = 97) (p < 0.05). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11%) (p < 0.05). The amount of received cognitive behavioural therapy (CBT) was higher among the stressed intervention group (16%) than among controls (10%) during follow-up.
CONCLUSIONS
The intervention group that used the WSQ with physicians' feedback had an increased number of rehabilitative measures and treatment more in line with established guidelines compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary healthcare and contribute to physicians' recommendations of suitable rehabilitative measures at an earlier stage compared to treatment as usual.
TRIAL REGISTRATION
ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.
背景
工作压力是社会日益加重的负担。在初级保健（PHC）中识别工作压力的早期症状可能会导致更早和更有针对性的治疗。工作压力问卷（WSQ）是为这项任务在 PHC 中开发的。我们的目的是评估在报告压力大的患者中，使用 WSQ 结合医生的反馈是否会导致医疗就诊和治疗与常规治疗（TAU）相比有所不同。我们的假设是，接受干预的患者在随访期间将比 TAU 产生更多的康复提供者就诊次数。
方法
在瑞典西约塔兰地区的七个初级保健中心（PHCC）进行了一项双臂随机对照试验。一组接受 WSQ 干预，对照组接受 TAU。18-64 岁的在职、未请病假的人员，因精神或身体健康问题到 PHCC 就诊，参加了该项研究。在纳入前 12 个月和纳入后 12 个月，获得了关于医疗就诊和治疗的登记数据，并与问卷数据（WSQ 和背景特征）一起使用 Fisher 精确检验进行了分析。
结果
共有 271 名参与者被纳入研究，132 名干预组和 139 名对照组。在随访期间，压力大的干预组中，有更多的参与者（20%，n=87）去看心理学家/心理治疗师，而相应的对照组（7%，n=97）（p<0.05）。纳入后，压力大的干预组中协作性护理措施更为常见（23%），而压力大的对照组中则较为少见（11%）（p<0.05）。在随访期间，压力大的干预组接受认知行为疗法（CBT）的比例高于对照组（16%对 10%）。
结论
与常规治疗相比，使用 WSQ 结合医生反馈的干预组接受了更多的康复措施，治疗也更符合既定指南。研究结果表明，WSQ 可以帮助识别初级保健中的工作压力，并有助于医生在常规治疗基础上，更早地推荐合适的康复措施。
试验注册
ClinicalTrials.gov。标识符：NCT02480855。注册于 2015 年 5 月 20 日。
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