Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Health Soc Care Deliv Res. 2024 Aug;12(23):1-105. doi: 10.3310/KDST3869.
Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common.
To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff.
Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation.
Four United Kingdom National Health Service hospitals from two urban and one rural Trust.
Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham.
Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines.
The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the 'amber' zone, then the trial would require modifications to proceed to full trial. If all were 'red', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only.
Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes.
There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities.
This trial is registered as ISRCTN10237475.
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in ; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.
员工病假缺勤和出勤（带病工作）给国民保健服务体系带来了高昂的成本，与不良的患者结局相关，并因 COVID-19 大流行而加剧。主要原因是精神和肌肉骨骼健康不良，心血管危险因素常见。
进行一项可行性研究，为一项针对国民保健服务人员健康筛查诊所的有效性和成本效益的确定性随机对照试验提供信息。
在常规护理的基础上，对员工健康筛查诊所进行个体随机对照试点试验，包括定性过程评估。
来自两个城市和一个农村信托的四家联合王国国民保健服务医院。
以前没有参加过伯明翰伊丽莎白女王医院试点健康筛查诊所的医院员工。
护士主导的员工健康筛查诊所，评估肌肉骨骼健康（STarT 肌肉骨骼；STarT 背部）、心理健康（患者健康问卷-9；广泛性焦虑症问卷-7）和心血管健康（如果年龄≥40 岁，进行国民保健服务健康检查，如果年龄<40 岁，则进行生活方式检查）。对筛查阳性者根据英国指南提供建议和/或转介服务。
三个主要结果是招募、转介和转介服务的就诊情况。当综合考虑时，这些构成了停止/继续的标准。如果这些值中的任何一个落入“琥珀色”区域，则试验将需要修改才能进行全面试验。如果全部为“红色”，则试验将被认为不可行。收集其他次要结果，为确定性随机对照试验的设计提供信息，包括：普遍性、筛查结果、所需/就诊的个别转介、健康行为、过程的可接受性/可行性、污染迹象和成本。与确定性试验相关的结果包括自我报告和员工缺勤记录及原因。过程评估包括对参与者、干预提供人员和服务提供者的访谈。呈现描述性统计数据，并对定性数据进行框架分析。由于 COVID-19 大流行，仅在 6 个月内收集了结果。
有 314 名参与者（236 名随机分配）同意参加，其中大多数在 4 个月内。邀请的 3788 人中的招募率为 314/3788（8.3%），低于预期（符合该标准的红色），但筛查表明，118/314（48.3%）随机分配的人有资格转介至全科医生（81%）、心理健康（18%）和/或物理治疗服务（30%）（绿色）。早期试验关闭排除了确定转介就诊情况的可能性，但有 31.6%的合格者报告打算就诊（琥珀色）。计划进行的 80 次定性访谈中的 51 次进行了访谈。过程评估的定量和定性数据表明，电子数据库驱动的筛查干预和数据收集效率高，促进了良好的保真度，尽管有时需要更多的个性化。招募和进行全面试验将受益于更长的开发期，以更好地了解当地情况，制定更有效的策略来吸引服务不足的群体，提供更长时间的培训，并更好地与转介服务整合。由于人员重新部署、COVID 研究优先事项和社区和内部转介服务可用性降低，试点工作受到了 COVID-19 的限制。虽然招募速度很快，但它并没有充分代表少数民族群体，由于资金限制，缩短的随访时间也阻止了对建议服务和次要结果的充分评估。
国民保健服务员工健康筛查诊所既有临床需求（有 48%的筛查者有资格获得转介），也有被认为是有益的（定性访谈的数据）。三个停止/继续的标准是红色、绿色和琥珀色；因此，试验监督委员会建议应继续进行全面试验，但需要进行修改，以适应当地情况，并采用更好的方法来吸引服务不足的社区。
该试验在 ISRCTN 注册，注册号为 ISRCTN174242。
该奖项由英国国家卫生与保健研究所卫生与社会保健交付研究计划（NIHR 奖 REF：17/42/42）资助，并在；第 12 卷，第 23 期。有关进一步的奖励信息，请访问英国国家卫生研究院的资助和奖励网站。
