The implementation of clinical guidelines concerning return to work after myocardial infarction

Abstract

Purpose

To examine the implementation, clinical effects, and adherence of occupational physicians to the clinical practice guidelines (CPG) published in 2003 in Israel, regarding return to work following acute myocardial infarction (AMI).

Methods

We analyzed 3 populations referred to Maccabi Health Services occupational clinics for fitness for work examinations following AMI, either before the guidelines were published (group 1), after their first publications in 2003 (group 2) or after they were re-published in Harefuah Journal in 2007 (group3).

Results

The documentation among groups 1,2,3 of different parameters like years of education (18.8%, 45.1%. 57.5%, p < 0.001), type of occupation (86.5%, 98.2%, 100.0%, p < 0.001) and New York Heart Association (NYHA) class (69.8%, 81.4%, 92.5%, p < 0.001) has all improved respectively over the years. No significant difference in sick leave was noted between the three populations.

Conclusion

The CPG should be interdisciplinary in the phase of writing and publication. Economical resources are needed in order to implement CPG.

Implications for Rehabilitation

1. The clinical practice guidelines should be interdisciplinary in the phase of writing and should involve all rehabilitation professionals as a team.

2. The clinical practice guidelines need disseminating widely alongside a resource plan in order to implement it.

Keywords:

• Outcome assessment
• guidelines adherence
• myocardial infarction
• fitness for work
• return to work

Ethical approval

The study was approved by Maccabi Healthcare Services ethical committee. Approval number 45/2013 was given on 29.12.2013.

Author contributions

AK contributed to the conception of the study, supervised the data analysis, and drafted the manuscript. MZ contributed to the conception of the study, collected the data, and supervised the data analysis. GH drafted the manuscript, performed data analysis, and performed a critical review of the manuscript. YSK performed the literature review, drafted the manuscript, and performed a critical review of the manuscript. LR performed a critical review of the manuscript. SM contributed to the conception of the study, performed the data analysis, and performed a critical review of the manuscript. All authors read and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).