In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain

Abstract

Objective

The objective of this study was to determine the effectiveness of a training to increase collaboration between general practitioners and occupational health physicians in the treatment of patients with low back pain (LBP) because more collaboration might improve a patient's recovery and shorten sick leave.

Methods

In a controlled trial, the intervention in one region was compared with usual care in a control region. Participating physicians enrolled patients with LBP on sick leave for 3–12 weeks. Patients filled out three questionnaires: at inclusion, at 3 months, and at 6 months. Information on sick leave was gathered from occupational health services. All analyses were performed on an intention-to-treat basis.

Results

Fifty-six patients with LBP were enrolled in each region. There was little collaboration between physicians during the project. Patients in the intervention region returned to work significantly later (P = .005) but were significantly more satisfied with their occupational health physician (P = .01). No differences were found between the intervention and control patients for pain, disability, quality of life, and medical consumption.

Conclusion

Our study does not show a positive effect of the training to increase collaboration between general practitioners and occupational health physicians. The training may not have improved collaboration enough to influence the prognosis of LBP.

Introduction

Low back pain (LBP) is a common reason for sick leave and work disability. In The Netherlands, the period prevalence during 12 months of self-reported LBP in the general population was 44% in 1998; 6% of these people were on sick leave for more than 4 weeks in the past year because of LBP [1].

Each company in The Netherlands is obliged to offer their employees access to occupational health care. The occupational health physician (OHP) is usually only consulted by employees on sick leave. The OHP evaluates fitness for work and is required by law to make a proposal for reintegration activities if the expected sick leave will exceed 6 weeks. Every person is registered with a general practitioner (GP), usually in his or her hometown. People consult their GP on their own initiative. The GP is responsible for diagnosis, treatment, and, if necessary, referral to (para)medical care. It is not their task to provide certification for sickness absence or to evaluate fitness for work resumption [2]. Due to the different roles of the OHP and the GP, most people on sick leave because of LBP visit the GP and the OHP and may experience some differences in advice.

Because the GP and the OHP give advice to people on sick leave on different aspects of their health problems, several studies have recommended more collaboration between these physicians [3], [4], [5]. When physicians collaborate more and coordinate their treatment and rehabilitation, the patient receives coordinated advice. It is expected that this will improve the recovery of the LBP patient and, as a consequence, may shorten the sick leave period. The Dutch Association of General Practitioners and the Dutch Association for Occupational Medicine signed a covenant in 1997 in which they stated that more collaboration is desirable and essential. In practice, however, there is hardly any collaboration [3], [4], although physicians have stated that they appreciate its potential benefits, believe that the quality of their own work could improve, and that collaboration may lead to a shorter duration of sick leave for the patient [3]. There are various reasons for the observed lack of collaboration in the Netherlands. One important reason is the difference in professional responsibility between the GP and the OHP. Other reasons are more practical, such as lack of time or not knowing whom to call, and social psychologic reasons, such as a mutual lack of trust [3], [4], [6].

Few evaluation studies on collaboration are available. A recent systematic review on interprofessional education [7] confirmed this lack. Therefore the current study aimed to determine the effectiveness of a training designed to increase collaboration between GPs and OHPs in the treatment of patients with LBP in a controlled clinical trial.