Improved recording of work relatedness during patient consultations in occupational primary health care: A cluster randomized controlled trial using routine data

Abstract

Background: Prolonging working careers is a key policy goal in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers, through preventing illnesses that cause work disability and early pensions. Impacting on the trajectory between illness and work disability requires continuity of care, enabled through identifying those at risk and their follow-up. We aimed to determine whether a combined educational and electronic reminder system could improve the recording of patient primary healthcare visits and follow-up of patients at risk of work disability or with work related illnesses in occupational health care, and through this, to impact on sickness absence rates. Methods: This study is a pragmatic cluster randomized controlled trial using medical record data. An occupational primary healthcare provider’s units in Finland were randomized into an intervention group consisting of both education and electronic reminders, and a control group with usual care using minimization methods. Data on patient visits were extracted from routine patient registers collected by Pihlajalinna Työterveys from 2015 to 2017. Process indicators were collected from the electronic system. Data were cleaned and analysed intention-to-treat using ANCOVA. Results: There was no significant difference between intervention and control sites in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians’ practice following the educational component of the intervention. Conclusion: Education with an electronic reminder can change physicians’ practice, but longer term follow-up is needed to determine whether this impacts on patients’ sickness absences.