Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Abstract

Aims: To explore the experiences of GPs, vocational advisors and patients towards a new vocational advice (VA) service in primary care, using qualitative interviews. Methods This study was nested within the Study of Work And Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire.Interviews took place with 10 GPs 12 months after the introduction of the VA service, 4 vocational advisors whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the 'constant comparative' method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were 1) the timing of referrals to the VA, 2) the perceived lack of patient demand for the service, and 3) role uncertainty experienced by VAs. Conclusions Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

The Development and Content of the Vocational Advice Intervention and Training Package for the Study of Work and Pain (SWAP) Trial (ISRCTN 52269669)

“…These were that: (1) the VAI needed to be delivered early; (2) patients should be accessed easily, for example, via the GP as many people off sick and struggling at work consult with a GP; (3) the VAs needed to work collaboratively with patients to identify and provide practical solution to help them to remain or return to work; (4) the VAI should involve all stakeholders, although this is particularly challenging when intervening early. The structure, format, content and methods of delivery of the VAI training were informed by evaluations of training offered to healthcare professionals (HCPs) [ 17 ] as part of two previous trials, STarT Back [ 23 ] and IMPaCT Back [ 24 ]. Additional sources included; (i) peer reviewed publications and evidence based guidelines [e.g., 17 , 22 , 25 – 27 ]; (ii) existing training in vocational case management, occupational health and vocational rehabilitation (e.g.…”

“…The delivery seems particularly problematic: it is known that adoption rates for complex interventions in primary care are low [ 14 ], so it is important to take appropriate steps to ensure fidelity between the evidence and what is actually delivered. The Study of Work and Pain (SWAP) trial was delivered in six general practices in the United Kingdom and aimed to determine whether the addition of an early vocational advice service to best current primary care could reduce work absence in patients consulting their GP for musculoskeletal pain who were either absent from work or struggling to remain in work because of their pain [ 15 – 17 ]. The trial demonstrated that the Vocational Advice Intervention (VAI) significantly reduced days absent over 4 months and was cost effective compared to best care [ 16 ].…”

“…This paper details the development of the early VAI, and describes the structure and content of the training and mentoring package developed to equip the Vocational Advisors (VAs) to deliver it. It is a companion paper to three other papers, the SWAP trial protocol paper [ 15 ], the SWAP trial results paper [ 16 ] and a qualitative paper exploring the acceptability of the VAI to general practitioners, the VAs and patients [ 17 ].…”

Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669)

“…18 The finding that there was a difference in GP-certified periods of absence could have been related to the visibility of the VAs in the practice, suggesting that raising the profile of available VA services providing VA may be of benefit. The qualitative analyses conducted alongside this trial was unable to elucidate the reasons for the decrease in the issue of fit notes, 27 and further work is needed to identify whether the availability of a VA service does change GP behaviour reducing the issue of fit notes or Table 2 Summary of VA service delivered. Number of stakeholder contacts 125…”

Yonder: Burnout, musculoskeletal pain, clinical leadership, and the female aging body

“…In a qualitative study linked to this trial, clinicians and patients from the practice were asked about their experiences of the service. 2 The key factors determining the perceived effectiveness of the service were the timing of referrals, the perceived lack of patient demand for the service, and role uncertainty experienced by those delivering the vocational rehabilitation (trained physiotherapists). Many patients felt they didn't need the service, often because their issues were self-limiting, or because they already had support mechanisms in place to return to work.…”