Effect of guideline adherence

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• Effect of guideline adherence
• on return to work.
• Preliminary results of a prospective cohort study
  among employees with psychological complaints.

Jenny Huijs, Roland Blonk, Shirley Oomens
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Contents presentation

• Problem description
• Aim of study
• Method
• Results
• Conclusion
• Questions Discussion

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Problem description

• Incidence of mental health problems
• Work-related consequences
• What do we know
• Activation interventions with a (early) focus on
  work are effective
• Mainly interventions by OP among employees with
  mild disorders
• Development guideline Work and psychological
  complaints, a guideline for psychologists

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Aim of the study

• To examine the effects of guideline adherence by
  psychologists
• on RTW and psychological complaints among
  employees on sick
• leave due to common mental health disorders.

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Method (1)

• Prospective cohort study with one-year follow-up
• National recruitment of psychologists
• Recruitment of clients (employees, sick leave)
• Method of measure
• Questionnaires (baseline, 3, 6, 12 months)
• Interviews
• Variables
• Mean percentage duration in days till RTW
• Psychological complaints (BSI)
• Other i.e. Background (work personal life),
  Self-efficacy, Coping, Working conditions
• Guideline adherence
• Outcome measures
• RTW (cox regression, logistic regression)
• Full RTW y/n
• Duration in days till full RTW

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Method (2)

• Guideline indicators -gt interview
• Examples guideline indicators
• Did you talk about the working experience of the
  client?
• Did you know for how many hours or the client
  was absent at the beginning of the treatment?
• Did you talk about factors in the workplace that
  obstruct RTW?
• Did you talk about factors in the workplace that
  reduce psychological complaints?
• Did you talk about factors outside of the
  workplace that stimulate RTW?
• Did you talk about the working conditions of the
  client?
• Do you know if a plan for RTW is made?
• Did you talk about how to prevent relapse?

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Method (3)

• Psychologists
• Response N131 included in analysis N90
• 74 female, mean age 45 (25-67), mean years of
  working as psychologist 11
• Mixed sample (type of psychologists, type of
  company etc.)
• Knowledge of guideline 2.5, use of guideline 2.2
  (both 1-5)
• Guideline adherence 25.3 (13-30)
• Employees
• Employees absent from work due to psychological
  complaints
• Response N196 included in analysis N98
• 55 female, mean age 44 (25-61), 81 stable
  relationship
• Mixed sample (education level, type of job,
  company size etc.)
• Sickness absence at baseline mean 8 weeks
  (1-32)
• Normal working hours, mean 33 (14-40)

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Results (1)

• Psychological complaints
• Main effect of time
• RTW ( RTW irt contract)
• Main effect of time
• Duration full RTW 154 days
• But what about guideline adherence?

Mean baseline SD Mean 6 mnth SD Sig.
1.12 0.64 .56 .61 .00
Mean baseline SD Mean 6 mnth SD Sig.
17.5 27.0 77.2 37.2 .01
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Results (2)

• Analyses on 3 outcomes with overall score
  guideline adherence as
• covariate
• No differences found!
• Possible explanations
• Too many indicators applied by everyone
• Too small variance of overall score
• Too small sample
• Look at single indicators of adherence
• Univariately
• Multivariately

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Results (3)

• A few indicators have an influence univariately,
  for instance
• Did you talk about the work experience of the
  client?
• Did you talk about factors in the workplace that
  stimulate RTW?
• Did you talk about factors in the workplace that
  increase psychological complaints?
• Did you talk about labour relations of the
  client?
• Did you advise or carried out interventions where
  work related aspects were integrated?
• But multivariately effects diminish.

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Results (4)

• Duration till full RTW
• 179 days (83-336)
• 140 days (34-287)

• Select extreme groups only
• Score of 13-22 (N14)
• Score of 28-30 (N31)
• But no significant difference
• B .23, p.58
• Small sample
• Big variance within duration till full RTW

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Conclusion so far

• Some differences found, but no significant
  effects.
• Guideline is not specific enough
• Too little variance
• Some psychologists already implement work in
  their therapy
• Small sample
• Majority of psychologists already implement the
  guideline in their usual treatment
• Improvement of guideline
• More specific
• Not only do this, but also how to do this
• Results with all the data?

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