Impact of improved recording of work-relatedness in primary care visits at occupational health services on sickness absences: study protocol for a randomised controlled trial

Abstract Background Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year. Methods/design A pragmatic trial will be conducted using patient electronic registers and registers of the central pensions agency in Finland. Twenty-two occupational health centres will be randomised to intervention and control groups. Intervention units will receive training to improve recording of work ability illnesses in the primary care setting and improved follow-up procedures. The intervention impact will be assessed through examining rates of sickness absence across intervention and control clinics as well as before and after the intervention. Discussion The trial will develop knowledge of the intervention potential of primary care for preventing work disability pensions and sickness absence. The use of routine patient registers and pensions registers to assess the outcomes of a randomised controlled trial will bring forward trial methodology, particularly when using register-based data. If successful, the intervention will improve the quality of occupational health care primary care and contribute to reducing work disability. Trial registration ISRCTN Registry reference number ISRCTN45728263 . Registered on 18 April 2016

General needs assessment for an evidence-based medicine curriculum - a survey among general practitioners involved in teaching

Introduction: Practice- and patient-oriented evidence-based medicine (EBM) curricula can improve patient care. Curriculum development is based on an initial needs assessment of the targeted participants. It is unknown whether general practitioners (GPs) involved in teaching are actually interested in EBM curricula. Therefore, the aim of this study was to quantitatively and qualitatively assess the interest of these GPs in further training in EBM. Methods: Our 202 GPs were involved in a written survey using standardized questionnaires addressing their interest in and proposals for EBM curricula, along with their favored topics. Data on course fee and time the teaching physicians are willing to invest for EBM curricula were also collected. Results: The response rate was 70 percent (n = 141). Among the respondents, 64 percent were interested in EBM curricula (n = 90), 23 percent were not (n = 23), and 13 percent were unsure (n = 18). The most favored topics were "Guidelines" (64 percent, n = 69), "Meta-Analysis" (60 percent, n = 65), "Critical Reading" (54 percent, n = 58), and "Asking Research Questions" (49 percent, n = 53). The 43 proposals were related to course themes (e.g., physician-patient interaction, socio-ethical aspects, health economics, and prevention) and teaching methods (e.g., continuous courses, Internet platforms, e-learning, reports, case reports, own reports). Almost 40 percent of the responding GPs were willing to invest up to six to eight hours in an EBM curriculum (n = 33). On the other hand, according to about one-third (n = 27), EBM curricula should be held continuously. Sixty-four percent of the responding GPs (n = 77) were willing to pay a maximum of 25 euros per curriculum lesson. Conclusion: The results suggest that it would be effective to offer at first a short EBM curriculum for GPs involved in teaching. A continuous curriculum might also be considered. A test calculation or a test run should be performed to check whether a course can be financed with the fee found acceptable.Einleitung: Praxis- und patientenorientierte EbM (Evidenz-basierte Medizin)-Curricula können die Patientenversorgung verbessern. Curriculums-Entwicklung in der Medizin basiert auf einem Qualitätssicherungsprozess mit initialer Bedürfnisanalyse der Beteiligten. Es ist nicht bekannt, ob bei niedergelassenen Allgemeinmedizinern überhaupt Interesse an Fortbildung in EbM besteht. Ziel der Untersuchung war es deshalb, die quantitative und qualitative Interessenlage von Lehrärzten der Allgemeinmedizin für Fortbildung in EbM zu erheben. Methodik: Alle 202 Lehrärzte unserer Fakultät wurden in einer freiwilligen, anonymisierten und standardisierten Briefumfrage zu ihrem Interesse an einem EbM-Curriculum, ihren favorisierten Themen und ihren Vorschlägen sowie zu Zeitaufwand und Teilnahmekosten befragt. Ergebnisse: Die Rückantwortrate lag bei 70 Prozent (n=141). Von diesen bekundeten 64 Prozent (n=90) Interesse an einem EbM-Curriculum, 23 Prozent (n=33) kein Interesse und 13 Prozent (n=18) Unentschlossenheit. Die am meisten favorisierten Themen waren "Leitlinien" (64 Prozent, n=69), "Meta-Analysen" (60 Prozent, n=65), "Kritisches Lesen" (54 Prozent, n=58) und "Recherche-Fragen stellen" (49 Prozent, n=53). Die Großteile der insgesamt 43 Vorschläge betrafen Kursthemen (z. B. Arzt-Patient-Interaktion, sozial-ethische Aspekte, Gesundheitsökonomie, Prävention) und Lehrmethoden (regelmäßiges Angebot, Internet-Plattform, e-learning, Vorträge, Fallbeispiele, eigene Referate). Fast 40 Prozent jener Lehrärzte, die Angaben zur Zeitaufwendung machten (n=83), wünschen höchstens bis zu sechs bis acht Stunden Fortbildung in EbM (n=33). Andererseits gab rund ein Drittel (n=27) an, dass ein EbM-Curriculum kontinuierlich (also in regelmäßigen Abständen) angeboten werden sollte. Vierundsechzig Prozent der Lehrärzte, die Angaben zu Teilnehmerbeiträgen machten (n=77), wären bereit, höchstens bis zu 25 Euro pro Kursstunde zu bezahlen (n=49). Schlussfolgerung: Die Ergebnisse ermutigen zunächst zum Angebot eines kurzen EbM-Curriculums für Lehrärzte in Allgemeinmedizin. Darüber hinaus kann ein kontinuierliches Konzept eingeplant werden. Eine Vorabkalkulation bzw. ein Probelauf müsste klären, ob mit den akzeptierten Teilnehmerbeiträgen derartige Angebote auszurichten sind