title: 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.
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Karlijn M
authors.initials: KM
authors.lastname: van Beurden
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands. e.p.m.brouwers@tilburguniversity.edu.
authors.forename: Evelien P M
authors.initials: EPM
authors.lastname: Brouwers
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Margot C W
authors.initials: MCW
authors.lastname: Joosen
authors.affiliation: Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Michiel R
authors.initials: MR
authors.lastname: de Boer
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.|Phrenos Centre of Expertise, PO Box 1203, 3500 BE, Utrecht, The Netherlands.|Parnassia Group, Dijk en Duin Mental Health Center, PO Box 305, 1900 AH, Castricum, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.affiliation: Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.|Netherlands School of Public & Occupational Health, PO Box 20022, 3502 LA, Utrecht, The Netherlands.
authors.forename: Jac J L
authors.initials: JJL
authors.lastname: van der Klink
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D009786:Occupational Health Services / Q000592:standards*; D016016:Proportional Hazards Models; D062707:Return to Work / Q000706:statistics & numerical data*; D057566:Self Report; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Mental health; Occupational health service; Occupational medicine; Practice guideline; Return to work