Limited change in the quality of the social medical guidance and in the satisfaction of sick-listed patients, after collaborative projects between general practitioners and occupational physicians
To evaluate whether regional projects for collaboration between general practitioners (GPs) and occupational physicians (OPs) improved the quality of their social medical guidance (SMG) and the satisfaction of their patients.
Evaluation study with before and after measurements with respect to the same GPs and OPs.
Structured interviews were conducted with 58 GPs and 83 OPs regarding the SMG of their sick-listed patients. Before the project, the SMG of 1109 sick-listed patients was assessed and after the project, 1 or 1.5 years later, the SMG of 1121 sick-listed patients. These patients were sent a questionnaire by means of which their satisfaction could be assessed.
After the projects, the quality ofthe diagnosis by the OPs was improved and they also more often adhered to the official guidelines of the KNMG (Royal Netherlands Medical Association) when contacting the GP about a patient. The GPs more often contacted the OP if they needed more information about a patient after reaching a diagnosis. Nevertheless, in half to three-quarters of the patients for whom contact between GPs and OPs was indicated, this contact did not take place. There was no significant increase in patient satisfaction. Before the projects, patients gave their GP a grade of 8.2 on a 10-point scale and after the projects this was 8.5; the OPs were given a grade of 7.5 both times. Further analysis showed that there was no significant relation between the quality ofthe SMG and the patient's satisfaction with the doctor.
Although there was some improvement in the quality of the SMG, there was still insufficient cooperation between GPs and OPs compared to the guidelines. An increase in patient satisfaction was not demonstrated.
Available from: Willem van Mechelen
- "Due to Dutch legislation, patients with paid work who do not RTW within six weeks after surgery, are generally consulted by their Occupational Physician (OP). However, as a result of the lack of recognised guidelines on the resumption of (work) activities and poor communication between the gynaecologists, General Practitioners (GPs) and OPs, often indistinct and conflicting recommendations are given and additionally most physicians do not differentiate according to the type of surgery [9-11]. These factors contribute to uncertainties and irrational beliefs of patients, which may result in delayed recovery, prolonged sick leave and reduced quality of life [12,13]. "
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ABSTRACT: Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed.
We designed a randomized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery, compared to usual clinical care. Two hundred twelve women (18-65 years old) undergoing hysterectomy and/or laparoscopic adnexal surgery on benign indication in one of the 7 participating (university) hospitals in the Netherlands are expected to take part in this study at baseline. The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery. Secondary outcome measures are the effect of the care program on general recovery, quality of life, pain intensity and complications, and are assessed using questionnaires at baseline, 2, 6, 12 and 26 weeks after surgery.
The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably.
Netherlands Trial Register (NTR): NTR2087.
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ABSTRACT: In the Netherlands there is a strict separation between the attending physician, i.e. the general practitioner, and the occupational physician. However, they are supposed to cooperate so that sick-listed patients will return to work earlier. It has now been demonstrated that this cooperation is far from sufficient and that all the expended effort has not led to an increase in patient satisfaction. It has to be admitted that the cooperation has failed. There is a strong need for adherence to guidelines, for quality audits and for scientific investigation in this sector.
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