Abstract
BackgroundProlonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers through preventing illnesses that cause work disability and early retirement. However, impacting on the trajectory between illness and work disability requires continuity of care and follow up, enabled through identifying patients at risk. We aimed to determine whether a combined educational and electronic reminder system in occupational health care could improve the recording and follow up of primary care visits made by patients at risk of work disability, and whether the system could impact on sickness absence rates.MethodsThis study is a pragmatic, cluster-randomized controlled trial using medical record data. Twenty-two Pihlajalinna Työterveys units were randomized into an intervention group receiving education and electronic reminders or a group receiving usual care through minimization methods. Patient consultation data were extracted from routine Pihlajalinna Työterveys patient registers from 2015 to 2017. In addition, process indicators were collected from the electronic system. Data were cleaned and analysed on an intention-to-treat basis using analysis of covariance.ResultsThere was no significant difference between intervention and control units in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians’ practice of recording patients’ risk of work disability and work-relatedness of visits following the educational intervention.ConclusionEducation with an electronic reminder can change physicians’ practice, but long-term follow up is needed to determine whether this impacts on patients’ sickness absences.Trial registrationISRCTN Registry: ISRCTN45728263. Registered on 12 April 2016.
Highlights
Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex
We report short-term sickness absences and the process indicators collected on recording work relatedness and risk of work disability at consultations across the control and intervention sites
There were differences between women at the intervention and control sites in terms of age, proportion of registered employees visiting without sick leave, total number of visits, and medium-term and short-term sickness absences
Summary
Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers through preventing illnesses that cause work disability and early retirement. Impacting on the trajectory between illness and work disability requires continuity of care and follow up, enabled through identifying patients at risk. We aimed to determine whether a combined educational and electronic reminder system in occupational health care could improve the recording and follow up of primary care visits made by patients at risk of work disability, and whether the system could impact on sickness absence rates. Economics and personal health influence decisions about whether to continue at work at pension age [3]. A more pressing problem in European settings is the increasing number of disability pensions, which at least in Finland mostly affects young people of working age [4]. In 2015 the disability pension expenditure in Finland was 2057 million euros [7]
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