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OCCUPATIONAL MEDICINE CALENDAR

In this issue of Occupational Medicine

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Evaluation of a workshop on evidence-based medicine for social insurance physicians

Background Evidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine.

Aims We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations.

Methods Sixty-six social insurance physicians followed a 1-day introductory workshop that focused on teaching two EBM core skills: to ask answerable questions and to search for the best evidence. All outcomes were measured before, immediately after and 3 months after the workshop by means of self-assessment. The primary outcomes were knowledge, skills, attitude and intention to apply EBM in practice. The secondary outcomes were social influence, self-efficacy and behaviour.

Results Immediately after the workshop, a marked and significant improvement was seen in self-assessed skills (mean difference 4.2, 95% CI 3.7–4.6) and in self-efficacy to apply EBM (mean difference 0.7, 95% CI 0.6–0.8). For attitude, knowledge and intention, the improvements were small. Three months after the workshop, the improvements in skills (mean difference 2.3, 95% CI 1.8–2.9) and self-efficacy (mean difference 0.5, 95% CI 0.3–0.6) remained significant.

Conclusions The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.

Return-to-work policies in Finnish occupational health services

Aim To describe return-to-work services for employees on sick leave offered by Finnish occupational health services (OHS).

Methods Finnish OHS are surveyed every 3 years. Respondents are asked if they offer services to facilitate return to work (RTW), and if so, to describe them. The description was qualitatively analysed using the Atlas-ti programme to find the themes that best describe the services. We also studied characteristics of OHS predicting a return-to-work policy.

Results Of the total sample of 969 occupational health units, 95% responded to the survey. Forty-one per cent reported offering services for facilitating RTW after sick leave. The service usually consisted of occupational physician examination of employees on sick leave for ~6 weeks. This was followed by a joint discussion between employee, physician and supervisor, which could result in work accommodation or a work trial period. There was a substantial variation, with only 10% mentioning a joint meeting and 13% mentioning a work trial period or work accommodation. Return-to-work policies were more frequently found in the OHS that served only a few employers, provided more group activities and collaborated more with employers and research institutes.

Conclusion Less than half of Finnish OHS offer return-to-work services of which the contents show wide variation that is not in line with current scientific evidence. A guideline project for return-to-work practices is needed to fill the gap. More research is needed to best define monitoring and screening practices for workers on sick leave.