Abstract
BackgroundEmployment 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/designA 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.DiscussionThe 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 registrationISRCTN Registry reference number ISRCTN45728263. Registered on 18 April 2016.
Highlights
The intervention will improve the quality of occupational health care primary care and contribute to reducing work disability
The employer needs collaboration with occupational health services (OHS) that can provide information regarding the early signs of work disability
Our hypothesis is that closer patient follow-up will enable the occupational health (OH) and employer teams to address work ability problems earlier and reduce sickness absences and disability pension rates
Summary
The wealth of registers, especially in Nordic countries, allows for innovative research to be conducted with minimal need for additional data collection or trouble for the participants. Changing behaviour on the basis of one training visit may be too optimistic; physicians may continue not to record work-relatedness or impact on work ability optimally; internal structures may not support collecting and following up employer visits; or employers may not be eager to invest in employee work ability. Through this randomised trial, we will be able to assess whether our approach works, and we will conduct important methodological work on using electronic registers for pragmatic trials.
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