Early identification in primary health care of people at risk for sick leave due to work-related stress - study protocol of a randomized controlled trial (RCT).

Kristina Holmgren,Ute Bültmann,Maria E H Larsson,Ann-Charlotte Mårdby,Christine Sandheimer,Gunnel Hensing,Dominique Hange

doi:10.1186/s12889-016-3852-9

Abstract

BackgroundEarly identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular. Tho date, no established method to do this exists. This project’s aim is to evaluate whether systematic early identification of work-related stress can prevent sickness absence. This paper presents the study design, procedure and outcome measurements, as well as allocation and baseline characteristics of the study population.Method/designThe study is a two-armed randomized controlled trial with follow-up at 3, 6 and 12 months. Non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers (PHCC) were eligible to participate. At baseline work-related stress was measured by the Work Stress Questionnaire (WSQ), combined with feedback at consultation, at PHCC. The preventive intervention included early identification of work-related stress by the WSQ, GP training in the use of WSQ, GP feedback at consultation and finding suitable preventive measures. A process evaluation was used to explore how to facilitate future implementation and structural use of the WSQ at the PHCC. The primary outcome to compare the preventive sick leave intervention by the general practitioner (GP) versus treatment as usual is sick leave data obtained from the Swedish Social Insurance Agency register.DiscussionEarly screening for sick leave due to work-related stress makes it possible not only to identify those at risk for sick leave, but also to put focus on the patient’s specific work-related stress problems, which can be helpful in finding suitable preventive measures. This study investigates if use of the WSQ by GPs at PHCCs, combined with feedback at consultation, prevents future sickness absence.Trial registrationClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015

Highlights

Identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular
This study investigates if use of the Work Stress Questionnaire (WSQ) by general practitioner (GP) at primary health care centers (PHCC), combined with feedback at consultation, prevents future sickness absence
After the baseline data collection was completed at each PHCC, all intervention GPs at that particular PHCC were invited to focus group discussions that explored the GPs’ perception of the systematic use of the WSQ

Summary

Discussion

There is a high level of sickness absence in Sweden, and stress-inducing factors at work play a large part in the sickness absence rate. Prolonged exposure to adverse psychosocial work conditions can cause stress, which in turn can lead to poor health This scenario constitutes an obvious risk for people to be sick-listed [41,42,43]. The GPs, though, report little knowledge of work-related factors [21, 24], and rarely talk to their patients about organizational and psychosocial work-related factors [26, 27] It is, essential to identify the patient at risk of being sick-listed at an early stage. This study is expected to show if early identification of work-related stress, using the WSQ, combined with feedback at consultation, can serve as a method for health care professionals in PHCCs to prevent or reduce sickness absence over a 12-month follow-up. In addition to using the questionnaires on GPs’ readiness and feasibility in the process evaluation, they will be analyzed in relation to the outcome variables

Background

Method and design

Findings