Effects of Adding Early Cooperation and a Work-place Dialogue Meeting to Primary Care Management for Sick-listed Patients with Stress-related Disorders: CO-WORK-CARE-Stress - a Pragmatic Cluster Randomised Controlled Trial

Overview

Journal Scand J Prim Health Care

Specialty Public Health

Date 2024 Mar 31

PMID 38555865

Authors

C Bjorkelund

E-L Petersson

I Svenningsson

A Saxvik

L Wiegner

G Hensing

I H Jonsdottir

M Larsson

C Wikberg

N Ariai

S Nejati

D Hange

Affiliations

Soon will be listed here.

Abstract

Objectives: To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.

Design: Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.

Setting: PCCs in Region Västra Götaland, Sweden, with care manager organisation.

Participants: Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder ( = 142 intervention, = 116 control PCCs).

Intervention: Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs.

Main Outcome Measures: 12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months.

Results: There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 - 138.8); control, mean = 99.1 days (95% CI 73.9 - 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%.

Conclusion: Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation. ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.

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PMID: 39503437 PMC: 11834767. DOI: 10.1080/02813432.2024.2421588.

References

Nieuwenhuijsen K, Verbeek J, Neumeyer-Gromen A, Verhoeven A, Bultmann U, Faber B . Interventions to improve return to work in depressed people. Cochrane Database Syst Rev. 2020; 10:CD006237. PMC: 8094165. DOI: 10.1002/14651858.CD006237.pub4. View

Karlson B, Jonsson P, Palsson B, Abjornsson G, Malmberg B, Larsson B . Return to work after a workplace-oriented intervention for patients on sick-leave for burnout--a prospective controlled study. BMC Public Health. 2010; 10:301. PMC: 2894773. DOI: 10.1186/1471-2458-10-301. View

Hoff A, Fisker J, Poulsen R, Hjorthoj C, Rosenberg N, Nordentoft M . Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with stress-related disorders: results from a randomized trial. Scand J Work Environ Health. 2022; 48(5):361-371. PMC: 9527782. DOI: 10.5271/sjweh.4021. View

Holst A, Labori F, Bjorkelund C, Hange D, Svenningsson I, Petersson E . Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial. Cost Eff Resour Alloc. 2021; 19(1):52. PMC: 8369323. DOI: 10.1186/s12962-021-00304-5. View

Wolvetang S, van Dongen J, Spekle E, Coenen P, Schaafsma F . Sick Leave Due to Stress, What are the Costs for Dutch Employers?. J Occup Rehabil. 2022; 32(4):764-772. PMC: 9109658. DOI: 10.1007/s10926-022-10042-x. View

Petersson E, Tornbom K, Hange D, Nejati S, Jerlock M, Wikberg C . The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study. BMC Fam Pract. 2020; 21(1):272. PMC: 7749497. DOI: 10.1186/s12875-020-01348-x. View

Jaaskelainen A, Kausto J, Seitsamo J, Ojajarvi A, Nygard C, Arjas E . Work ability index and perceived work ability as predictors of disability pension: a prospective study among Finnish municipal employees. Scand J Work Environ Health. 2016; 42(6):490-499. DOI: 10.5271/sjweh.3598. View

Hassard J, Teoh K, Visockaite G, Dewe P, Cox T . The cost of work-related stress to society: A systematic review. J Occup Health Psychol. 2017; 23(1):1-17. DOI: 10.1037/ocp0000069. View

Lindegard A, Glise K, Wiegner L, Reinhardt P, Ellbin S, Pettersson S . Effects of Additional Individually Tailored Interventions on Sick-Leave and Symptoms in Patients with Exhaustion Disorder: A Randomized Controlled Trial. J Rehabil Med. 2022; 54:jrm00321. PMC: 9422869. DOI: 10.2340/jrm.v54.2941. View

10.

Arends I, Bruinvels D, Rebergen D, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A . Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev. 2012; 12:CD006389. PMC: 11627150. DOI: 10.1002/14651858.CD006389.pub2. View

11.

Theorell T, Hammarstrom A, Aronsson G, Traskman Bendz L, Grape T, Hogstedt C . A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 2015; 15:738. PMC: 4522058. DOI: 10.1186/s12889-015-1954-4. View

12.

Bjorkelund C, Svenningsson I, Hange D, Udo C, Petersson E, Ariai N . Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial. BMC Fam Pract. 2018; 19(1):28. PMC: 5807835. DOI: 10.1186/s12875-018-0711-z. View

13.

Bjorkelund C, Saxvik A, Svenningsson I, Petersson E, Wiegner L, Larsson M . Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability - a pragmatic cluster randomised.... BMJ Open. 2023; 13(6):e074137. PMC: 10277141. DOI: 10.1136/bmjopen-2023-074137. View

14.

Karlson B, Jonsson P, Osterberg K . Long-term stability of return to work after a workplace-oriented intervention for patients on sick leave for burnout. BMC Public Health. 2014; 14:821. PMC: 4137088. DOI: 10.1186/1471-2458-14-821. View

15.

Aronsson G, Theorell T, Grape T, Hammarstrom A, Hogstedt C, Marteinsdottir I . A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health. 2017; 17(1):264. PMC: 5356239. DOI: 10.1186/s12889-017-4153-7. View

16.

Saxvik A, Svenningsson I, Tornbom K, Petersson E, Bjorkelund C, Gabartaite G . GPs' experiences of a collaborative care model for patients with common mental disorders who need sick leave certification: a qualitative study. BJGP Open. 2022; 6(4). PMC: 9904781. DOI: 10.3399/BJGPO.2022.0042. View

17.

Bengtsson Bostrom K, Starzmann K, Ostberg A . Primary care physicians' concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden. Scand J Prim Health Care. 2020; 38(2):146-155. PMC: 8570729. DOI: 10.1080/02813432.2020.1753341. View

18.

Udo C, Svenningsson I, Bjorkelund C, Hange D, Jerlock M, Petersson E . An interview study of the care manager function-Opening the door to continuity of care for patients with depression in primary care. Nurs Open. 2019; 6(3):974-982. PMC: 6650652. DOI: 10.1002/nop2.277. View

19.

Sundquist J, Ohlsson H, Sundquist K, Kendler K . Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated. BMC Psychiatry. 2017; 17(1):235. PMC: 5493066. DOI: 10.1186/s12888-017-1381-4. View

20.

Salomonsson S, Santoft F, Lindsater E, Ejeby K, Ljotsson B, Ost L . Cognitive-behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial. Occup Environ Med. 2017; 74(12):905-912. DOI: 10.1136/oemed-2017-104342. View