This is the largest RCT ever conducted on effects of a multiple component return-to-work intervention (coordinated, tailored, and multidisciplinary). The effects of the intervention on duration of sickness absence were remarkably different between the three municipalities examined indicating that contextual factors are of major importance for success or failure of this complex intervention. 47Original article Scand J Work Environ Health. 2014;40(1):47-56. doi:10.5271/sjweh.3383 Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities Objectives The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities. MethodsThe intervention group comprised 1948 participants while the control group comprised 1157 participants receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI). ResultsThe intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M1 1.12, 95% CI 0.97-1.29, and HR M3 0.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR. ConclusionThe effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.Key terms coordinated case management; Denmark; effect evaluation; intervention; multidisciplinary; RTW; work resumption. In 2008, the annual level of sickness absence in Denmark corresponded to approximately 5% of the workforce, and reimbursement costs per year were estimated to be around €5 billion (approximately €1350 per capita age 18-64 years) not including treatment costs or loss of productivity (1). Promoting labor market participation is essential for Denmark and other European countries facing a decline in the proportion of people of working age due to an aging workforce (2). To reduce sickness absence and improve labor market participation, the Danish Government launched an action plan in 2008 encompassing 39 initiatives including the Danish returnto-work (RTW) program. The Danish National Research Centre for the Working Environment (NRCWE) was appointed to develop the program in accordance with the action plan, existing sickness management leg...

Although widely recommended, the implementation of a multidisciplinary, coordinated and tailored approach in RTW-management is not an easy task. Evaluating the implementation of the Danish RTW program in 21 municipalities showed that especially the establishment of well-functioning interdisciplinary RTW-teams, early assessment and more frequent cooperation with employers was challenging. A better understanding of these challenges is needed to improve implementation. Affiliation:

The total load of drugs influence the degree of intoxication and the total concentration level must be considered, including the total number of substances. Our findings imply that international statistics regarding an opioid being the main intoxicant should have a shift in focus towards combinations of drugs (especially opioids and benzodiazepines) as a major risk factor for fatal drug overdoses.

ISRCTN43004323.

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