Effectiveness of an Intervention to Enhance Occupational Physicians’ Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial

Abstract

Purpose Evidence-based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration. Notwithstanding that, guideline adherence of occupational physicians (OPs) is limited. Based on the literature on guideline implementation, an intervention was developed that was shown to effectively improve self-reported adherence in OPs. The aim of present study was to evaluate whether this intervention leads to earlier return to work (RTW) in workers with common mental disorders (CMD). Methods In a two-armed cluster randomized controlled trial, 66 OPs were randomized. The trial included 3379 workers, with 1493 in the intervention group and 1886 in the control group. The outcome measures were: time to full RTW, time to first RTW, and total hours of sickness absence. Cox regression analyses and generalized linear mixed model analyses were used for the evaluations. Results The median time to RTW was 154 days among the 3228 workers with CMD. No significant differences occurred in (time to) full RTW between intervention and control group HR 0.96 (95% CI 0.81–1.15) nor for first RTW HR 0.96 (95% CI 0.80–1.15). The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group. Conclusions The intervention to enhance OPs’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs. Possible explanations are the remaining external barriers for guideline use, and that perceived guideline adherence might not represent actual guideline adherence and improved care.Trail registration: ISRCTN86605310.

Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis

“…Generally, these interventions did not significantly improve full time RTW (Van Beurden et al 2015 , 2017 ; Oostrom et al 2009 ; Noordik et al 2013 ; Hees et al 2013 ; Feltz-Cornelis et al 2010 ) after 3–18 months follow-up among individuals with CMD. The only exception was that educating the physician to work with the psychiatrist (Feltz-Cornelis et al 2010 ) which showed a statistically significant effect on RTW after 3 but not after 6 months.…”

Use of a mental health guideline by occupational physicians and associations with return to work in workers sick-listed due to common mental disorders: a retrospective cohort study

“…We merged data from the intervention and control groups of the larger study, which was adequate, provided that the intervention was not effective [31]. Although the intervention did not affect return to work [32] and did not substantially affect the degree of guideline adherence [Joosen et al, submitted], we could not rule out the possibility that the intervention might have had a modifying effect on the association between guideline adherence and return to work. Therefore, we tested the intervention for effect modification in all analyses.…”

Prevention of Common Mental Disorders in Employees. Perspectives on Collaboration from Three Health Care Professions

“…Subsequently, special training was provided for the occupational health physicians to enhance guideline adherence and hence improve return to work for the employees they treated. The randomized controlled trial did not result in the earlier return to work of employees who were guided by the trained occupational health physicians [ 23 ]. However, taking workplace conditions into consideration during psychotherapy treatment is considered important for therapy planning [ 24 ] and has been shown to improve patient’s work ability [ 25 , 26 ].…”

“…Despite the compelling need for collaboration in mental health care, implementation remains a challenge [ 16 , 22 ] and training only one of the groups of collaborators appears to be insufficient [ 23 ]. Concentrating on primary care physicians and attuning them to anxiety may even be detrimental, as it reduced the labor force participation rates reported in a study from Yelin et al in 1996 [ 36 ].…”