Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
BMC Fam Pract. 2021 Sep 8;22(1):179. doi: 10.1186/s12875-021-01526-5.
The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care.
This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas.
The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24).
Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality.
Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019 .
在瑞典的初级保健中，使用认知行为疗法（CBT）来应对精神困扰和疼痛问题已经帮助了许多患者。然而，CBT 减少病假的效果并不那么令人信服。接受和承诺疗法（ACT）是传统 CBT 的一种发展，我们旨在研究基于 ACT 的员工教育是否可以减少初级保健中的病假。
这是在卡尔马（登记的总受试者为 28930 人）的 6 个初级保健中心进行的一项前瞻性试验，其中工作人员（医生、护士和治疗师）在 2018 年和 2019 年期间接受了基于 ACT 的小组教育。将这些效果与附近约恩舍平地区的 5 个类似规模的对照保健中心进行了比较，这些中心没有进行此类教育。主要目的是研究卡尔马的 6 个初级保健中心的病假变化，并通过研究约恩舍平的病假来跟踪更普遍的趋势，让 2017 年的病假成为两个地区的参考期。
卡尔马保健中心的工作人员报告说，他们在卡尔马的 Kadowaki 精神病学家处参加了平均 5.2±2 次基于 ACT 的教育课程。ICD-10 F43（严重应激和相关调整障碍反应）的病假从 2017 年的平均每月 28.7±9.1 个病假减少到 2018 年的每月 22.6±7.0 个病假（-21%，p=0.033），到 2019 年的每月 18.1±10 个病假（-37%，p=0.038）。任何诊断（总病假）的相应病假从 2017 年的每月 132±39 个病假减少到 2018 年的每月 118±38 个病假（-11%，p=0.056），到 2019 年的每月 102±37 个病假（-21%，p=0.021）。对照保健中心的相应病假比较没有显示出任何显著变化（所有 p 值均≥0.24）。
在工作人员接受基于 ACT 的教育干预的第二年，卡尔马保健中心的每月平均总病假减少了 21%，而在约恩舍平则没有变化。这表明，对于接受过 ACT 教育的初级保健患者，这种方法可以显著减少长期病假。本试验的结果可以作为一项随机试验的基础，以确定因果关系。
2018 年 11 月 9 日在 ClinicalTrials.gov 上预先注册，编号为 NCT03737019。
