Feasibility trial of GP and case-managed support for workplace sickness absence

Abstract

The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up. Findings In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.

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

“…Of those studies that have tested interventions to manage work absence in those with health conditions [ 47 , 48 ], the Fit for Work Service pilots tested different models of delivering vocational advice however only 21% of referrals came from general practice [ 48 ]. A more recent UK study aiming to provide vocational advice in primary care lacked GP engagement leading to poor recruitment [ 49 ]. The SWAP trial was therefore the first to provide an early VAI, embedded in UK general practice, to people with musculoskeletal pain, a leading cause of work absence.…”

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

“…These include clinical knowledge which was not found to be a key requirement in either a systematic review or focus groups with vocational advisors [26,27]. It has been suggested that interpersonal skills may be more important than a health background when defining the VA role [29,30]. The level of clinical knowledge required for the VA role is centred on understanding the potential for disability or functional limitations that a condition leads to, and hence the likely impact on work participation [24].…”

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)

“…In intervention practices, VAs actively engaged in practice life, joining breaks and staff meetings and providing both formal and informal feedback about the service to GPs. This was important, given the difficulty in engaging GPs in studies of VA and has been reported by Rannard et al 26 and the Fit for Work pilots. 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.…”