A protocol improves GP recording of long-term sickness absence risk factors

Process evaluation of the 'Grip on Health' intervention in general and occupational health practice

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.

Nieuwe wegen naar arbocuratieve samenwerking: samen werken van praktijkondersteuners huis- en bedrijfsarts bij multiproblematiek

Achtergrond: Momenteel is er nauwelijks sprake van arbocuratieve samenwerking tussen de eerstelijns- en bedrijfsgezondheidszorg. Waar eerdere initiatieven tot verbetering vooral gericht waren op de huis- en bedrijfsarts, onderzoeken we in deze bijdrage welke rol praktijkondersteuners van de huisarts (POH-ggz en POH-S) en van de bedrijfsarts (POB) voor zichzelf zien bij multiproblematiek. Tevens exploreren we welke belemmeringen er zijn voor arbocuratieve samenwerking door praktijkondersteuners bij multiproblematiek.

Methode: We hebben drie focusgroepgesprekken uitgevoerd met zeven POH’s-ggz, elf POH’s‑S en acht POB’s – 26 praktijkondersteuners in totaal.

Resultaten: De praktijkondersteuners in ons onderzoek komen tijdens hun werk in aanraking met multiproblematiek. POH’s en POB’s zien een rol voor zichzelf weggelegd bij het bespreken en het bieden van ondersteuning bij respectievelijk werk- en privégerelateerde klachten. Daarbij erkennen ze, waar nodig, het belang van arbocuratieve samenwerking om goede zorg te leveren. Op dit moment vindt er echter geen directe samenwerking plaats op het niveau van de praktijkondersteuner. Belemmeringen hiervoor blijken de formele regels rond taakdelegatie en rolopvatting van de POB, onbekendheid en vooroordelen bij vooral POH’s wat betreft de bedrijfsgezondheidszorg, en praktische barrières als de AVG-wetgeving en bereikbaarheid.

Conclusie: POH’s en POB’s staan open voor arbocuratieve samenwerking, mits een oplossing gevonden wordt voor deze fundamentele en praktische belemmeringen.

Reducing sick leave of Dutch vocational school students: adaptation of a sick leave protocol using the intervention mapping process

OBJECTIVES

Since the extent of sick leave and the problems of vocational school students are relatively large, we aimed to tailor a sick leave protocol at Dutch lower secondary education schools to the particular context of vocational schools.

METHODS

Four steps of the iterative process of Intervention Mapping (IM) to adapt this protocol were carried out: (1) performing a needs assessment and defining a program objective, (2) determining the performance and change objectives, (3) identifying theory-based methods and practical strategies and (4) developing a program plan. Interviews with students using structured questionnaires, in-depth interviews with relevant stakeholders, a literature research and, finally, a pilot implementation were carried out.

RESULTS

A sick leave protocol was developed that was feasible and acceptable for all stakeholders. The main barriers for widespread implementation are time constraints in both monitoring and acting upon sick leave by school and youth health care.

CONCLUSIONS

The iterative process of IM has shown its merits in the adaptation of the manual 'A quick return to school is much better' to a sick leave protocol for vocational school students.

An education programme to increase general practitioners' awareness of their patients' employment: design of a cluster randomised controlled trial

BACKGROUND

Work and being able to work are important prerequisites for health and well being. Health problems can have a negative influence on the ability to work and not being able to work can be detrimental for patients' psychosocial well being. Although GPs are aware of this importance they do not always structurally pay attention to patients' work during their daily practice.

METHODS/DESIGN

To investigate whether GPs can be trained to increase their awareness of work and improve their skills when dealing with work related problems we designed a cluster randomised controlled trial. The intervention in this trial is a tailored training based on the findings of qualitative research with focus groups of GPs. Gender aspects received specific attention in these focus groups. Primary outcome measures are self efficacy of patients concerning return to work, and GPs' use of ICPC code Z05 (work problems) and registration of patients' occupation. Secondary outcome measures are work awareness of GPs as perceived by patients, quality of life, health, use of care and illness related costs. A process evaluation will be part of our study.

DISCUSSION

We investigate a training to increase work awareness among GPs, improve their skills in managing work related problems and structurally register work related data in the EMR. We think this study will make a contribution to better health care for workers by motivating GPs to appreciate their specific needs. It will also add to our knowledge of the complex relationship between gender, work and health.

Concise set of files for smooth return to work in employees with mental disorders

Sick leave due to mental disorders is a societal problem. It carries a high cost in terms of loss of labor productivity and absenteeism. Partial remission increases the risk of relapse after a return to work. There is sometimes a difference between the ability to return to work as judged by a general practitioner (GP) and the needs of the workplace. GPs are the main controllers of treatment and tend to protect their patients. Communication and agreement by GPs and occupational physicians play an effective role in the return to work. However, it requires considerable effort for both of them to make time to do this. We have developed a concise set of files for a smooth return to work. The files consist of three parts: “Suggestions for corresponding with employees taking sick leave”; “Checklist for smooth return to work”; and “Pattern of living”. We put them into practice among 20 companies in Japan from January 2012 to October 2013. The companies had 8244 workers in total and 116 workers were on sick-leave due to mental disorders. Our set of files contributed to sharing the written basic policy of return to work among employees on sick leave with mental disorders, GPs, occupational physicians and personnel officers. That sharing led to facilitating a smooth return to work. Although there are differences in the legal and medical systems between Japan and other countries, our concept of sharing the written basic policy may give some help to occupational physicians in other parts of the world as well.