501 Development and pilot testing of a triage tool for sickness absence counselling of sick-listed workers without an employment contract

Abstract

Introduction Sick-listed workers without a (relative) permanent employment relationship, e.g. temporary agency workers and unemployed workers, are at higher risk for prolonged work disability compared to sick-listed employees. It is therefore important to start sickness absence counselling as early as possible. Triage – the process of prioritising patients on the base of the urgency of need for care – may facilitate this. The aim of this study was to develop and pilot test a triage tool to identify quickly the necessary intensity of counselling by het Social Security Agency (SSA) for sick-listed workers without an employment contract. Methods Literature review, interviews and expert opinions were used to develop an initial triage tool. The developed tool consisted of a digital self-reported questionnaire for the worker and a (programmed) set of decision rules. Workers without an employment contract who were sick-listed between November 2016 and May 2017 at two locations of the Dutch SSA were requested to complete the questionnaire. Usability of the triage tool was evaluated by means of four group interviews with the occupational health care professionals of the SSA (e.g. sickness absence counsellors, insurance physicians). Results The triage tool incorporated the workers perspective regarding the period of sickness absence, health status, their disability and several other risk factors. Approximately 5.300 sick-listed workers completed the questionnaire. The sickness absence counsellors were able to handle 27% of them without the direct assistance of an insurance physician. Results showed satisfaction with both the questionnaire and the decision rules among the professionals. Also, points of improvement were identified. Conclusion This study indicates feasibility of the proposed triage tool, to effectively determine the necessary intensity of occupational health care interventions for sick-listed workers without an employment contract. To overcome important barriers and construct an optimal triage model, attention should be paid to further improve the questionnaire and decision rules.