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de Wit M, van Asselt KM, Mak-van der Vossen M, de Boer AGEM. Let's talk about work: pilot study of an education program on discussing work participation with cancer patients for general practitioners in training. BMC MEDICAL EDUCATION 2024; 24:739. [PMID: 38982451 PMCID: PMC11232123 DOI: 10.1186/s12909-024-05705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Cancer patients report that they lack support from healthcare providers when it comes to returning to or maintaining employment. In the education of general practitioners (GPs) in the Netherlands, there is little attention given to discussing work participation with patients. The aim of this pilot study was to evaluate a newly developed education program for GPs in training that focuses on discussing work participation with cancer patients. METHODS Two groups of in total twenty-one GPs in training participated in the education program. GPs were educated about the importance of discussing work participation with patients, work-related problems cancer patients can experience, and advice they can give to support cancer patients regarding work issues. In this pilot study using a mixed-method design, participants evaluated the program in two self-developed questionnaires and in a focus group discussion. RESULTS Seventeen participating GPs (81%) indicated that the education program was suitable for implementation in the education curriculum. Eleven participants (52%) reported that they had never discussed work participation with cancer patients before. Directly after the education program, eighteen participants (86%) reported that they planned to discuss work participation more often with their patients. Four months after the program, 67% indicated they had applied their new knowledge and skills in practice by discussing work participation and by referring cancer patients to occupational health professionals or online resources. According to the GPs in training, integrating the topic of work participation into other education for GPs in training and focusing on a broader group of patients could improve the impact of the education program. CONCLUSIONS According to the results of this pilot study, the newly developed education program increased the awareness of GPs in training on the importance of discussing work participation with cancer patients. Future studies should focus on whether cancer patients experience more support from their GPs for maintaining and returning to employment after their GP has participated in the training program.
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Affiliation(s)
- Mariska de Wit
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Coronel Institute of Occupational Health, Meibergdreef 9, PO Box 22700, Amsterdam, 1100 DE, The Netherlands.
- Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Kristel M van Asselt
- Department of General Practice and Nursing science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne Mak-van der Vossen
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Coronel Institute of Occupational Health, Meibergdreef 9, PO Box 22700, Amsterdam, 1100 DE, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Møller A, Bond CB, Andersen LN, Hartvigsen J, Stochkendahl MJ. General practitioners' stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program. Scand J Prim Health Care 2023; 41:445-456. [PMID: 37837433 PMCID: PMC11001345 DOI: 10.1080/02813432.2023.2268674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVES To describe current stay-at-work practices among Danish general practitioners (GPs) in relation to patients with musculoskeletal disorders, to identify potential avenues for improvement, and to suggest a training program for the GPs. DESIGN AND SETTING We followed the principles of Intervention Mapping. Data were collected by means of literature searches, focus group interviews with GPs, and interaction with stakeholder representatives from the Danish labour market. RESULTS GPs' current stay-at-work practices were influenced by systemic, organisational, and legislative factors, and by personal determinants, including knowledge and skills relating to stay-at-work principles and musculoskeletal disorders, recognition of the patient's risk of long-term work disability, their role as a GP, and expectations of interactions with other stay-at-work stakeholders. GPs described themselves as important partners and responsible for the diagnostic and holistic assessments of the patient but placed themselves on the side line relying on the patient or workplace stakeholders to act. Their practices are influenced both by patients, employers, and by other stakeholders. We propose a training course for GPs that incorporate both concrete tools and behaviour change techniques. CONCLUSIONS We have identified varied perspectives on the roles and responsibilities of GPs, as well as legislative and organisational barriers, and proposed a training program. Not all barriers identified can be addressed by a training course, and some questions are left unanswered, among others - who are best suited to help patients staying at work?
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Affiliation(s)
- A. Møller
- Research Unit for General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C. B. Bond
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L. N. Andersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J. Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - M. J. Stochkendahl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Kluit L, van Bennekom CAM, Beumer A, Sluman MA, de Boer AGEM, de Wind A. Clinical Work-Integrating Care in Current Practice: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10143-1. [PMID: 37966538 DOI: 10.1007/s10926-023-10143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. METHODS A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. RESULTS In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. CONCLUSION Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.
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Affiliation(s)
- Lana Kluit
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands.
| | - Coen A M van Bennekom
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Annechien Beumer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Upper Limb Unit Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Maayke A Sluman
- Department of Cardiology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Astrid de Wind
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
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4
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Sarfo MC, van Asselt KM, Frings-Dresen MH, de Jong F, van Dijk N, de Boer AGEM. Views of breast cancer survivors on work participation guidance by general practitioners: a qualitative study. BMC PRIMARY CARE 2022; 23:152. [PMID: 35715735 PMCID: PMC9205136 DOI: 10.1186/s12875-022-01768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
Background Breast cancer survivors can be at high risk of having work-related problems. Previous studies suggest that GPs could discuss work participation with cancer patients and provide guidance. The aim this study is to explore the experiences and expectations of breast cancer survivors with their GPs’ role regarding guidance on work participation and return to work. Methods A qualitative study with Dutch female breast cancer survivors was held in the Netherlands. Four focus groups with 25 participants were conducted and audio-taped. Transcripts were analysed using thematic analysis. Results Breast cancer survivors reported a wide range of experiences with guidance from their GPs regarding work participation. Patients who contacted their GPs with work-related issues felt listened to during the consultation. Some patients experienced very limited or no guidance, while others were intensively guided by their GPs. The guidance was provided in the form of counseling, psychosocial support, and referral to other health care professionals. When cancer patients experienced problems with reintegration in work, they expected GPs to have a supportive and referring role in work participation guidance. Conclusion In returning to work, breast cancer survivors expect their GPs to play a supportive role, especially when they encounter difficulties in reintegrating. However, their actual experience of guidance received from their GPs varied, from none received at all, to intensive support provided.
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Furlan AD, Harbin S, Vieira FF, Irvin E, Severin CN, Nowrouzi-Kia B, Tiong M, Adisesh A. Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:591-619. [PMID: 35511378 DOI: 10.1007/s10926-022-10043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.
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Affiliation(s)
- Andrea D Furlan
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada.
- KITE, University Health Network, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Shireen Harbin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Fabricio F Vieira
- Faculty of Medicine, State University of Maringa, Avenida Colombo, 5790, CEP 87020-900, Maringa, PR, Brazil
| | - Emma Irvin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret Tiong
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Anil Adisesh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Occupational Medicine, St Michael's Hospital, Toronto, ON, Canada
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Vossen E, van der Gulden JWJ, van Genabeek JA, Schaap R, Anema JR, Schaafsma FG. Process evaluation of the 'Grip on Health' intervention in general and occupational health practice. BMC Health Serv Res 2022; 22:1459. [PMID: 36451237 PMCID: PMC9713133 DOI: 10.1186/s12913-022-08801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND For working patients with a lower socioeconomic position, health complaints often result from a combination of problems on multiple life domains. To prevent long-term health complaints and absence from work, it is crucial for general and occupational health professionals to adopt a broad perspective on health and to collaborate when necessary. This study aimed to evaluate how the 'Grip on Health' intervention is implemented in general and occupational health practice to address multi-domain problems and to promote interprofessional collaboration. METHOD A process evaluation was performed among 28 general and occupational health professionals, who were trained and implemented the Grip on Health intervention during a six-month period. The 'Measurement Instrument for Determinants of Innovations' was used to evaluate facilitators and barriers for implementing Grip on Health. Data included three group interviews with 17 professionals, a questionnaire and five individual interviews. RESULTS While most health professionals were enthusiastic about the Grip on Health intervention, its implementation was hindered by contextual factors. Barriers in the socio-political context consisted of legal rules and regulations around sickness and disability, professional protocols for interprofessional collaboration, and the Covid-19 pandemic. On the organizational level, lack of consultation time was the main barrier. Facilitators were found on the level of the intervention and the health professional. For instance, professionals described how the intervention supports addressing multi-domain problems and has created awareness of work in each other's healthcare domain. They recognized the relevance of the intervention for a broad target group and experienced benefits of its use. The intervention period was, nevertheless, too short to determine the outcomes of Grip on Health. CONCLUSION The Grip on Health intervention can be used to address problems on multiple life domains and to stimulate interprofessional collaboration. Visualizing multi-domain problems appeared especially helpful to guide patients with a lower socioeconomic position, and a joint training of general and occupational health professionals promoted their mutual awareness and familiarity. For a wider implementation, stakeholders on all levels, including the government and professional associations, should reflect on ways to address contextual barriers to promote a broad perspective on health as well as on collaborative work.
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Affiliation(s)
- Emma Vossen
- grid.16872.3a0000 0004 0435 165XDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, Amsterdam, The Netherlands ,grid.450078.e0000 0000 8809 2093HAN University of Applied Sciences, Laan van Scheut 10, 6525 EM Nijmegen, The Netherlands
| | - Joost W. J. van der Gulden
- grid.10417.330000 0004 0444 9382Department of Primary and Community Care, Radboudumc, Geert Grooteplein Noord 21, 6525 EZ Nijmegen, The Netherlands
| | | | - Rosanne Schaap
- grid.16872.3a0000 0004 0435 165XDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, Amsterdam, The Netherlands
| | - Johannes R. Anema
- grid.16872.3a0000 0004 0435 165XDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, Amsterdam, The Netherlands
| | - Frederieke G. Schaafsma
- grid.16872.3a0000 0004 0435 165XDepartment of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, Amsterdam, The Netherlands
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Schaap R, Schaafsma FG, Huysmans MA, Bosma AR, Boot CRL, Anema JR. A Context Analysis with Stakeholders' Views for Future Implementation of Interventions to Prevent Health Problems Among Employees with a Lower Socioeconomic Position. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:438-451. [PMID: 34731392 PMCID: PMC8564794 DOI: 10.1007/s10926-021-10010-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
Purpose Health problems among employees with a lower socioeconomic position (SEP) often result from an interplay of problems on multiple life domains. Contextual factors greatly affect implementation of interventions that aim to solve these type of problems. The aim of this study was to gain insight into the organizational and socio-political context for implementation of preventive interventions that consider multiple life domains among employees with a lower SEP. Methods In total 16 semi-structured interviews were conducted with stakeholders at organizational level, occupational health service (OHS) level, and at socio-political macro level. Thematic analysis was performed to identify themes that describe the perceptions of stakeholders about the impact of contextual factors on implementation. Results The following themes were identified: (1) the importance of addressing problems on multiple life domains among employees with a lower SEP, (2) unclarity of responsibilities for solving problems on multiple life domains, (3) necessity of better collaboration between occupational and curative healthcare, (4) insufficient investments in prevention by employers, (5) difficulties in early identification of employees at risk for health problems, and (6) risk of conflicting role for supervisors in addressing problems on multiple life domains. Conclusions Implementation of preventive interventions considering multiple life domains among lower SEP employees is challenging, due to various contextual factors. To improve the feasibility, many different stakeholders both in- and outside occupational health practice need to be involved, collaborate, and need to be convinced of the added value to prevent problems on multiple life domains among employees with a lower SEP.
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Affiliation(s)
- R Schaap
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - F G Schaafsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - M A Huysmans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A R Bosma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Ruco A, Pinto AD, Nisenbaum R, Ho JW, Bellicoso E, Hassen N, Hanna A, Muntaner C, Holness DL. Collecting occupation and hazards information in primary care using O*NET. Am J Ind Med 2022; 65:783-789. [PMID: 35932171 DOI: 10.1002/ajim.23420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to determine the feasibility of collecting occupation and occupational hazard data in a primary care setting, using the Occupational Information Network (O*NET) database to assist with classification. METHODS We collected data from 204 employed adult primary care patients in Toronto, Canada, on their occupation and exposure to occupational hazards, and mapped their job titles to the O*NET database. We compared their self-reported occupational hazard exposures with the likelihood of exposure on O*NET. RESULTS Exposure to repetitive arm movement was reported by 78%, to vapors/gas/dust/fumes by 30%, to noise by 30%, and to heavy loads by 31%. Significant differences in exposure to vapors/gas/dust/fumes were associated with work precarity. We matched the majority of job titles (89%) to O*NET categories. CONCLUSIONS Collecting employment information in primary care setting was feasible, with the majority of job titles mapping onto O*NET classifications.
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Affiliation(s)
- Arlinda Ruco
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, ON, Canada
| | - Andrew D Pinto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Julia W Ho
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Emily Bellicoso
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Nadha Hassen
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada
| | - Andrew Hanna
- Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, Bahrain
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Research Expertise in Occupational Disease, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Occupational Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Occupational Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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9
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Kimachi M, Omae K, Kamitani T, Fukuma S. Primary care physicians' perceptions concerning engagement in cancer survivor care. J Gen Fam Med 2021; 23:149-157. [PMID: 35509332 PMCID: PMC9062547 DOI: 10.1002/jgf2.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Given the growing diversity among cancer survivors and the fact that oncologists typically do not perform long‐term care, the expected role of primary care physicians (PCPs) in survivor care is expanding. However, communication and collaboration between oncologists and PCPs are lacking. Therefore, we assessed the perception of cancer survivor care among PCPs. Methods We sent a questionnaire to 767 Japanese Board–certified PCPs, regardless of facility type (clinics and hospitals), inquiring about PCPs' perceptions of their role in survivor care. Additionally, we included vignette‐based scenarios focused on colorectal and prostate cancer survivors to explore factors associated with their clinical decisions. Results We obtained 91 replies (response rate: 11.9%). A total of 75% of PCPs had encountered at least 1 cancer patient in actual practice. Even for patients actively receiving cancer treatment, >70% of PCPs reported that they were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, 49% of PCPs considered that both PCPs and oncologists were suited to performing regular screening for cancer recurrence in high‐risk patients. Multivariable logistic regression analyses revealed that clinic PCPs were less inclined to conduct screening for recurrence than hospital PCPs in both colorectal (odds ratio, 3.85 [95% confidence interval 1.40–10.6]) and prostate (4.36 [95% confidence interval 1.51–12.6]) cancer scenarios. Conclusions Our findings suggest that Japanese PCPs are willing to engage in survivor care and encourage closer collaboration between oncologists and PCPs. However, oncologists might need to request cooperation, considering the facility type with which PCPs are affiliated. The present study revealed that Japanese primary care physicians (PCPs) were willing to engage in comprehensive survivor care, except for the administration of anticancer drugs. Further, most PCPs were willing to engage in psychosocial support to relieve survivors' anxiety and manage work‐related issues, but they have few opportunities to collaborate with oncologists. Oncologists and PCPs need to engage in more communication and conduct cancer survivor care while capitalizing on PCPs' willingness and capability.![]()
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Affiliation(s)
- Miho Kimachi
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
| | - Kenji Omae
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT) Fukushima Medical University Fukushima Japan
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shingo Fukuma
- Human Health Sciences Kyoto University Graduate School of Medicine Kyoto Japan
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10
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Xie Y, Hutting N, Bartys S, Johnston V. Interventions to Promote Work-Focused Care by Healthcare Providers for Individuals with Musculoskeletal Conditions a Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:840-865. [PMID: 33811292 DOI: 10.1007/s10926-021-09971-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Building on an emerging body of evidence, this scoping review aimed to provide an overview of current interventions to promote work-focused care by healthcare providers for individuals with musculoskeletal conditions and to identify current knowledge gaps for future research. METHODS Literature searches were performed in Pubmed, CINAHL, EMBASE, and PsycInfo using Medical Subject Heading terms and text words relating to musculoskeletal conditions, interventions to promote work-focused care and work-related outcomes. Articles involving any interventions with elements of work-focused care delivered by healthcare providers to manage musculoskeletal conditions were reviewed for suitability and inclusion. RESULTS A total of 22 articles (18 intervention trials) were identified. Most studies were multidisciplinary interventions incorporating one or more elements of work-focused care including: work-related assessment to identify barriers to working, vocational advice/coaching or education to address barriers to working, involvement of the workplace stakeholders, restoration of fitness for work and regular communication with multidisciplinary team members. Most studies (61 %) concluded that their interventions achieved the desired work-related outcomes although firm conclusions could not be made regarding the effectiveness of a particular component, content or strategy of work-focused care itself because of the variability in the type and number of elements and outcomes used. CONCLUSIONS There is good evidence demonstrating the potential for healthcare providers to improve work outcomes for those with musculoskeletal conditions. Additional training is required to increase confidence in this area of practice. Accepting that work-focused care is important, however, does not diminish the challenge it presents.
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Affiliation(s)
- Yanfei Xie
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Nathan Hutting
- Research Group Occupation and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Serena Bartys
- Centre for Applied Research in Health, School of Human & Health Sciences, The University of Huddersfield, Huddersfield, UK
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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11
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Oswald W, Ummels I, Raaijmakers T, Baart P, Staal JB, Bieleman HJ, Nijhuis-van der Sanden MWG, Heerkens YF, Hutting N. Therapists' experiences and needs with regard to providing work-focused care: a focus group study. BMC Musculoskelet Disord 2021; 22:923. [PMID: 34727896 PMCID: PMC8565033 DOI: 10.1186/s12891-021-04806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) can create a temporary or permanent disability that reduce a person's ability to work. Physiotherapists (PTs), occupational therapists (OTs) and exercise therapists (ETs) are often involved in the early management of MSDs. There is a need for additional insights into therapists' experiences, barriers and needs to work-focused care. Moreover, there is no evidence on how OTs and ETs address work participation. Therefore, the aim of this qualitative study was 1) to investigate how generalist PTs, OTs and ETs provide work-focused healthcare and 2) to obtain insight into their perceived barriers and needs that affect their ability to address occupational factors. METHODS An exploratory qualitative study using three focus groups. Generalist PTs, OTs and ETs were eligible to participate if they treated working patients with MSDs. A semi-structured interview guide with open-ended questions was developed. Two moderators facilitated each focus group using the interview guide, and all the groups were audio recorded. Data were analysed using inductive thematic analysis. RESULTS Sixteen therapists (mean age 44 years, range 25-59) participated in this study. Participants were aware of the importance of taking occupational factors into account. Whether they address occupational factors is largely dependent on the patient's request for help. However, ETs and OTs consider it normal to ask about occupational factors during the diagnostic process, while PTs often address this in later consultations. Almost all participants were unaware of the existence of PTs, OTs or ETs who are specialised in occupational health. Moreover, almost all participants struggled with when to refer a patient to other (occupational) healthcare professionals. This study identified several needs of therapists. These included knowledge about laws and legislation and skills for identifying and addressing work-related or work-relevant complaints. CONCLUSIONS Participants in this qualitative study were aware of the importance of taking occupational factors into account. However, how PTs, OTs and ETs address work participation and the extent to which they do so can be improved. There was a lack of knowledge about and cooperation with occupational health professionals, including PTs, OTs or ETs specialised in occupational health.
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Affiliation(s)
- Wiebke Oswald
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
- School for Allied Health, HAN University of Applied Sciences, Physical Therapy, Nijmegen, The Netherlands
| | - Inez Ummels
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | | | - Paul Baart
- Centre Work Health, Amersfoort, The Netherlands
| | - J Bart Staal
- School for Allied Health, HAN University of Applied Sciences, Key Factors in Physiotherapy and Allied Health Research Group, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, the Netherlands
| | - Hendrik J Bieleman
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | | | - Yvonne F Heerkens
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Nathan Hutting
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands.
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12
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Ehmann AT, Martus P, Siegel A, Rieger MA. Addressing future work ability of employees in GP consultations: results of a cross-sectional study. J Occup Med Toxicol 2021; 16:10. [PMID: 33752718 PMCID: PMC7983286 DOI: 10.1186/s12995-021-00299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives In this study we examined to what extent members of a best-practice integrated healthcare model in Germany discussed their subjective future work ability with their general practitioner (GP); furthermore, we examined independent variables which explain whether future work ability is discussed. Methods In a cross-sectional survey, 1168 (out of 3218 invited) integrated healthcare members responded to a standardized questionnaire. This study includes n = 475 employed respondents who were at most 65 years old. We determined the (relative) frequency of employed members up to 65 years who had already discussed their subjective future work ability with their GP. By means of logistic regression analysis, explanatory variables were identified which statistically explained the discussion of future work ability with their GP. Results N = 80 (16.8%) respondents stated they had discussed their future work ability with their GP. A multiple logistic regression analysis showed the following results: The odds ratio for discussing future work ability is increased the more satisfied respondents are with their general practitioner, the worse they assess their current work ability in relation to the physical demands of the job, and when respondents suffer from one or more chronic diseases (Nagelkerke’s pseudo-R2 = 0.13). Conclusions Even in this healthcare setting, employees up to the age of 65 rarely discussed their subjective future work ability with their GP. This suggests that the issue ‘future work ability’ is even less commonly discussed in other community-based care settings in Germany. It seems that health care providers involved in acute care only sporadically take this issue into consideration - despite the great importance of maintaining work ability. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-021-00299-y.
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Affiliation(s)
- Anna T Ehmann
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen, Silcherstr. 5, 72076, Tübingen, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
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13
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de Kock CA, Lucassen PL, Akkermans RP, Knottnerus JA, Buijs PC, Steenbeek R, Lagro-Janssen AL. Work-relatedness of the presented health problem and sickness absence. Fam Pract 2020; 37:360-366. [PMID: 31747001 PMCID: PMC7377345 DOI: 10.1093/fampra/cmz072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Perception by workers of their health problems as work-related is possibly associated with sickness absence (SA). The aim of this study was to to study the relationship between perceived work-relatedness of health problems and SA among workers who visit their GP, taking the influence of other potential determinants into account and to study the influence of these determinants on SA. Design and setting prospective cohort study in 32 Dutch GP practices. METHODS A secondary analysis of RCT data among workers, aged 18-63 years, who visited their GP. We measured self-reported SA days in 12 months and high SA (>20 days in 12 months) and compared workers who perceived work-relatedness (WR+) with workers who did not (WR-). With multivariable linear and logistic regression models, we analyzed the influence of age, gender, experienced health, chronic illness, prior SA, number of GP consultations and perceived work ability. RESULTS We analyzed data of 209 workers, 31% perceived work-relatedness. Geometric mean of SA days was 1.6 (95% CI: 0.9-3.0) for WR+- workers and 1.2 (95% CI: 0.8-1.8) for WR- workers (P = 0.42). Incidence of high SA was 21.5 and 13.3%, respectively (odds ratio 1.79; 95% CI: 0.84-3.84). SA was positively associated with chronic illness, prior SA, low perceived work ability and age over 50. CONCLUSIONS Perceived work-relatedness was not associated with SA. SA was associated with chronic illness, prior SA, low perceived work ability and age over 50.
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Affiliation(s)
| | | | - Reinier P Akkermans
- Department of Primary and Community Care.,Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Peter C Buijs
- TNO Work, Health and Care, Leiden, (retired in 2014)
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14
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Hutting N, Oswald W, Nijhuis-van der Sanden MWG, Filart M, Raaijmakers T, Bieleman HJ, Staal JB, Heerkens YF. The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the 'WORK TO BE DONE' cluster randomised controlled trial. BMC Musculoskelet Disord 2020; 21:360. [PMID: 32513153 PMCID: PMC7281957 DOI: 10.1186/s12891-020-03375-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient's work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health. METHODS/DESIGN This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients' care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients. DISCUSSION The trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism. TRIAL REGISTRATION Netherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518.
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Affiliation(s)
- Nathan Hutting
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - Wiebke Oswald
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
- School of Allied Health, Physical Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Monique Filart
- School of Health, Physical Therapy, Saxion University of Applied Sciences, Enschede, The Netherlands
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | | | - Hendrik J Bieleman
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | - J Bart Staal
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical centre, Nijmegen, The Netherlands
- School of Allied Health, Musculoskeletal Research Group, HAN University of Applied Sciences, Key factors in Physiotherapy and Allied Health Research Group, Nijmegen, The Netherlands
| | - Yvonne F Heerkens
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
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15
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Tobback E, Mariman A, Clauwaert L, Godderis L, Heytens S, Ruppol P, Spooren D, Tytgat R, De Muynck M, Vogelaers D. Opinion paper: the role of work in the management of medically unexplained physical symptoms. Acta Clin Belg 2019; 74:151-156. [PMID: 29726743 DOI: 10.1080/17843286.2018.1462754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Patients with medically unexplained physical symptoms suffer from chronic fatigue and/or pain in combination with a variety of other symptoms. A flexible, biopsychosocial approach is needed for diagnostic screening and global management. It is crucial to involve the direct patient environment, including family, friends, colleagues as well as health providers, evaluation, and reintegration sector. The aim of this paper is to review the importance of work in the management of medically unexplained physical symptoms. METHODS In this paper, different actors involved explain their views and handling concerning work in the management of MUPS. RESULTS Symptom severity and lack of understanding from the environment can negatively impact on earning an independent income from labor for years. Work, whether or not paid, is however, an important life domain with positive effects on physical, psychological, and social well-being. Therefore, health actors are pivotal in starting the professional reintegration process as soon as possible and should discuss this item from the early stage onward. Support services can be consulted in mutual interaction as required. A case manager, acting as a central intermediator within this multidisciplinary approach, may promote effective communication and coordination between the patients and their surrounding actors. CONCLUSION The professional reintegration process should start as soon as possible within the management of medically unexplained physical symptoms. As such, the care sector, the evaluation sector, and the professional integration sector should collaborate and effectively communicate with each other.
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Affiliation(s)
- Els Tobback
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lies Clauwaert
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lode Godderis
- Department of Occupational, Environmental and Insurance Medicine, Catholic University Louvain, Louvain, Belgium
| | - Stefan Heytens
- Department of General Practice and Primary Health Care, Ghent University, Gent, Belgium
| | - Patrick Ruppol
- Service for Specialized Guidance for Persons with Special Needs GTB, Ghent, Belgium
| | - Daniel Spooren
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Rita Tytgat
- Medical Department of the Christian Sickness Fund, Christian Sickness Fund, Brussels, Belgium
| | - Martine De Muynck
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
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16
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de Kock C, Noben C, Lagro-Janssen A, Lucassen P, Knottnerus A, de Rijk A, Nijhuis F, Steenbeek R, Evers S. Affecting patients with work-related problems by educational training of their GPs: a cost-effectiveness study. BMC FAMILY PRACTICE 2019; 20:38. [PMID: 30825880 PMCID: PMC6397438 DOI: 10.1186/s12875-019-0924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
Background Assessing the cost effectiveness of training aimed at increasing general practitioners’ (GP) work awareness and patients’ work-related self-efficacy and quality of life. Methods A cluster randomized controlled trial in twenty-six GP practices in the southeast of the Netherlands with 32 participating GPs. GPs working in an intervention group practice received training and GPs working in a control group practice delivered usual care. The training intervention consisted of lectures and workshops aimed at increasing GPs’ work awareness and more proactive counseling for patients with work-related problems (WRP). Subjects were working age patients with paid work for at least 12 h per week, who visited one of the participating GPs during the study period. As outcome measures we used the Return to Work Self Efficacy scale to assess patients’ work-related self-efficacy and the Euroquol to assess quality of life. We also measured health care costs and productivity costs. With a 4-item questionnaire we asked patients to assess their GPs’ work awareness. Data were collected at baseline, after 6 and 12 months. Results Data of 280 patients could be analyzed. The patient related outcomes did not improve after GP training. The change in GP work awareness and the overall mean cost difference (of €770) in favor of the intervention group were not significant. Conclusions The training intervention presented in this paper was not cost-effective. Training which is further personalized and targeted at high risk groups with respect to WRP, is more likely to be cost effective. Electronic supplementary material The online version of this article (10.1186/s12875-019-0924-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cornelis de Kock
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Cindy Noben
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,OOR ZON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Antoine Lagro-Janssen
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - André Knottnerus
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Frans Nijhuis
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | | | - Silvia Evers
- Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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17
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de Kock CA, Lucassen PLBJ, Bor H, Knottnerus JA, Buijs PC, Steenbeek R, Lagro-Janssen ALM. Training GPs to improve their management of work-related problems: results of a cluster randomized controlled trial. Eur J Gen Pract 2019; 24:258-265. [PMID: 30394151 PMCID: PMC6225437 DOI: 10.1080/13814788.2018.1517153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Paying attention to their patients’ work and recognizing work-related problems is challenging for many general practitioners (GPs). Objectives: To assess the effect of training designed to improve the care for patients with work-related problems in general practice. Methods: A cluster randomized controlled trial among 32 Dutch GPs. GPs in the intervention group received five-hour training. GPs in the control group were not trained. Included patients (age 18–63, working ≥12 h per week) completed baseline questionnaires and follow-up questionnaires planned after one year. Primary outcome at patient level was patients’ expectations about their ability to work, measured using the return-to-work self-efficacy scale (RTW-SE). Primary outcomes on GP level were their use of ICPC-code Z05 (‘work-related problem’) per 1000 working-age patients and percentage of the electronic medical files of working-age patients in which information about occupation had been recorded. Results: A total of 640 patients completed the baseline questionnaire and 281 the follow-up questionnaire. We found no statistically significant differences in patients’ RTW-SE scores: intervention 4.6 (95%CI: 4.2–5.0); control 4.5 (95%CI: 4.1–4.9). Twenty-nine GPs provided data about the GP-level outcomes, which showed no statistically significant differences: use of ICPC code Z05 11.6 (95%CI: 4.7–18.6) versus 6.0 (95%CI: –1.2 to 13.2) per 1000 working-age patients; recording of occupation 28.8% (95%CI: 25.8–31.7) versus 28.6% (95%CI: 25.6–31.6). Conclusion: Training GPs did not improve patients’ work-related self-efficacy or GPs’ registration of work-related problems and occupation.
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Affiliation(s)
- Cornelis A de Kock
- a Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands
| | - Peter L B J Lucassen
- b Department of Primary and Community Care, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands
| | - Hans Bor
- b Department of Primary and Community Care, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands
| | - J André Knottnerus
- c Department of General Practice , Maastricht University , Maastricht , The Netherlands
| | - Peter C Buijs
- d Health and Care , TNO Work , Leiden , The Netherlands
| | - Romy Steenbeek
- e Health, Technology , TNO Work , Leiden , The Netherlands
| | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care, Gender & Women's Health, Radboud University Medical Center , Radboud Institute for Health Sciences , Nijmegen , The Netherlands
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18
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de Jong F, Frings-Dresen MH, Dijk NV, van Etten-Jamaludin FS, van Asselt KM, de Boer AGEM. The role of the general practitioner in return to work after cancer-a systematic review. Fam Pract 2018; 35:531-541. [PMID: 29420712 DOI: 10.1093/fampra/cmx114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The number of cancer patients and survivors of working age is increasing. General Practitioners (GPs) may have a significant role in psychosocial cancer care, including work-related concerns. Therefore, we performed a systematic literature review to identify the role of the GP in work-related concerns and integration/reintegration into work of cancer patients and/or survivors. METHODS We searched PubMed, Embase, Cinahl, PsycINFO and Cochrane Library, irrespective of study design. We found 4863 articles and, after removing duplicates, we screened 3388 articles by title and abstract and reviewed 66 of these in full text. The Critical Appraisal Skills Programme tool was used to assess the methodological quality of included articles. We used narrative synthesis to describe the role of the GP. RESULTS We included four qualitative studies from three countries. Two of these studies focused on the health care professionals' perspectives and two studies focused on patients' perspectives regarding the role of the GP. Lack of communication between health care professionals, lack of knowledge about work-related concerns and limited resources were recurring themes in these papers. Fully establishing the role of the GP is difficult given the small number of studies on work-related concerns in cancer patients in primary care. CONCLUSION There is little evidence regarding the role of the general practitioner in cancer care and work guidance. Therefore, further research should focus on the role that is desired for GPs and on interventions to study the feasibility of GP involvement in the return to work of cancer patients and/or survivors.
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Affiliation(s)
- Femke de Jong
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Monique H Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | | | - Kristel M van Asselt
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Rivière M, Leroyer A, Ferreira Carreira L, Blanchon T, Plancke L, Melchior M, Younès N. Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study. BMJ Open 2018; 8:e020770. [PMID: 30082345 PMCID: PMC6078252 DOI: 10.1136/bmjopen-2017-020770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs. METHOD We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April-August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates. RESULTS Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%). CONCLUSIONS Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk.
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Affiliation(s)
- Mathieu Rivière
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
- Department of Infectious Diseases, Centre Hospitalier Régional, Orléans, France
| | | | | | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
| | - Laurent Plancke
- Regional Federation of Research in Psychiatry and Mental Health Hauts-de-France, Lille, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013, Paris, France
| | - Nadia Younès
- EA 40-47 University of Versailles Saint-Quentin, Versailles, France
- Academic Unit of psychiatry for adults, Versailles Hospital, Versailles, France
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20
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Younès N, Rivière M, Plancke L, Leroyer A, Blanchon T, Azevedo Da Silva M, Melchior M. Work intensity in men and work-related emotional demands in women are associated with increased suicidality among persons attending primary care. J Affect Disord 2018; 235:565-573. [PMID: 29698918 DOI: 10.1016/j.jad.2018.04.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A large proportion of persons died by suicide are employed at the time of death and work-related factors partly contribute to suicide risk. Our aim was to examine the association between multiple aspects of work organization and suicidal ideation in a study conducted in primary care. METHODS Data came from a study of 2027 working patients attending a GP representative of patients in the Nord Pas-de-Calais region in France (April-August 2014). Suicidality was assessed using the MINI (Mini International Neuropsychiatric Interview). Six emergent worked-related factors were explored (work intensity, emotional demands, autonomy, social relationships at work, conflict of values, insecurity of work). Several covariates were considered: patient's and GP's characteristics, and area-level data (material and social deprivation, psychiatrist and GPs' density, suicide attempts and suicide rates). RESULTS 8.0% of participants reported suicidal ideation in the preceding month (7.5% of men and 8.6% of women, p = .03). In multivariate analyses adjusted for covariates, suicidality was significantly associated with work intensity (OR = 1.65; 95%CI [1.18-2.31]) in men and with work-related emotional demands (OR = 1.35; 95%CI [1.01-1.80]) in women. Area-level data were not associated. LIMITATIONS Our cross-sectional study cannot assess the direction of the relationships under study. CONCLUSION Our results emphasise a central role for GPs in suicide prevention among workers and highlight the importance of work-related factors with regard to suicidality in primary care.
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Affiliation(s)
- N Younès
- EA 40-47 University of Versailles Saint-Quentin, Versailles, France; Academic Unit of Psychiatry for Adults, Versailles Hospital, Versailles, France.
| | - M Rivière
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France; Department of Infectious Diseases, Centre Hospitalier Régional, Orléans, France
| | - L Plancke
- Fédération régionale de recherche en psychiatrie et santé mentale Hauts-de-France, Lille, France
| | - A Leroyer
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France
| | - T Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - M Azevedo Da Silva
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France; EA 40-47 University of Versailles Saint-Quentin, Versailles, France
| | - M Melchior
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
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