Care onderzoekers in de landelijke pers - Nphf

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bulletin van de netherlands school of primary care research
◄ terUg Naar INHOUD
26
carré | jaargang 15 | nr 51 | maart 2010
ess of occupational health interventions. With respect
to exploring methodology, we asked three questions:
1. how well are studies conducted, 2. how are changes
in health-related productivity measured and valued,
and 3. what is relevant when we want to estimate the
cost of health-related productivity loss. To answer the
first two questions, we conducted systematic reviews.
To answer the third question, we conducted a modified
Delphi study with 36 Dutch experts representing
five different stakeholder
groups.
SOMeONe whO The three main findings from
COMeS TO wORk these three studies were as
whiLe STiLL SiCk follows. First, in general, the
methodological quality of
economic evaluations conducted
from a company’s perspective was poor. The
main shortcomings were related to how costs were
measured and valued, how outcomes were measured
and the testing of key assumptions. Second, the methods
used to measure and value changes in healthrelated
productivity varied widely between studies.
Third, what is considered relevant when estimating
costs of health-related productivity loss depends on
the type of productivity loss we are talking about. That
is, is someone sick for a few days or weeks or are we
talking about someone who comes to work while still
sick. The take home message from these three studies
was that specific guidelines for good practice are needed
for the field of occupational health research, and
future endeavours to develop such guidelines should
be conducted in collaboration with stakeholders.
With regards to generating new evidence on the
cost-effectiveness of occupational health interventions,
we conducted three economic evaluations using data
collected alongside randomized controlled trials. The
three trials involved workers with subacute, non-specific
low back pain, workers with stress-related sick
leave, and working mothers following childbirth. In the
first study involving workers of subacute non-specific
low back pain, usual care by an occupational physician
plus a graded activity treatment were compared to
usual occupational physician care. We found that the
graded activity program may potentially result in a
net saving of €500 due to less sick leave compared to
usual care, and we concluded that from a company’s
perspective, it may be worthwhile to implement
graded activity.
The second study involved workers with stressrelated
sick leave. One group received care by their
general practitioners who were trained in a minimal
intervention strategy based on coping, problem
solving and taking an active role in functional recovery
rather than focusing solely on symptom relief. The
other group was treated by their (untrained) general
practitioners as in usual practice. Our main finding
was that the minimal intervention for workers with
stress-related sick leave was not cost-effective in
improving quality of life or reducing sick leave compared
to usual care. A secondary finding was that the
minimal intervention appeared to be cost-effective for
a sub-group of workers with uncomplicated stressrelated
sick leave and no additional complaints of anxiety,
depression or physical symptoms. We concluded
that there was no evidence to replace usual care with
the minimal intervention strategy. However, further
research should be conducted to confirm our findings
about the subgroup.
The third study involved working mothers following
childbirth. One group received, in addition to the usual
congratulatory phone calls, cards and visits, a telephone
call from their supervisor 6-weeks after giving
birth. During this phone call, the supervisor conducted
a standardized interview to identify health problems
that may interfere with their ability to return-to-work
after the end of their maternity leave. The aim was to
ensure that women received timely support by occupational
health services. The other group received the
usual congratulatory phone calls, cards and visits. We
found that the early case management by the supervisor
was not effective and more expensive compared
to usual practice. Therefore, we concluded that there
was no evidence to replace usual practice.
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