Training GPs to improve their management of work-related problems: results of a cluster randomized controlled trial

Abstract

Background: Paying attention to their patients’ work and recognizing work-related problems is challenging for many general practitioners (GPs).

Objectives: To assess the effect of training designed to improve the care for patients with work-related problems in general practice.

Methods: A cluster randomized controlled trial among 32 Dutch GPs. GPs in the intervention group received five-hour training. GPs in the control group were not trained. Included patients (age 18–63, working ≥12 h per week) completed baseline questionnaires and follow-up questionnaires planned after one year. Primary outcome at patient level was patients’ expectations about their ability to work, measured using the return-to-work self-efficacy scale (RTW-SE). Primary outcomes on GP level were their use of ICPC-code Z05 (‘work-related problem’) per 1000 working-age patients and percentage of the electronic medical files of working-age patients in which information about occupation had been recorded.

Results: A total of 640 patients completed the baseline questionnaire and 281 the follow-up questionnaire. We found no statistically significant differences in patients’ RTW-SE scores: intervention 4.6 (95%CI: 4.2–5.0); control 4.5 (95%CI: 4.1–4.9). Twenty-nine GPs provided data about the GP-level outcomes, which showed no statistically significant differences: use of ICPC code Z05 11.6 (95%CI: 4.7–18.6) versus 6.0 (95%CI: –1.2 to 13.2) per 1000 working-age patients; recording of occupation 28.8% (95%CI: 25.8–31.7) versus 28.6% (95%CI: 25.6–31.6).

Conclusion: Training GPs did not improve patients’ work-related self-efficacy or GPs’ registration of work-related problems and occupation.

Keywords:

• Work-related problems
• general practitioners
• randomized controlled trial
• return-to-work self-efficacy
• educational training

Acknowledgments

The authors thank all participating GPs, practice receptionists and patients for making this study possible, and Berend Terluin and Liesbeth Smits for their contribution to the training programme. The authors also wish to thank Margriet Straver, Lea Peters, Anouk Peters, Annetje Dieleman and Francine van den Driessen Mareeuw for their indispensable assistance with the data collection and Hugo de Waal for his help with the English language.

Ethics

The institutional medical research ethics committee (MREC) concluded that the ‘Medical Research Involving Human Subjects Act’ did not apply to our study (letter MREC 6 April 2011).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

Foundation Institute Gak [grant number 2008-762].