Affecting patients with work-related problems by educational training of their GPs: a cost-effectiveness study.

BACKGROUND: Assessing the cost effectiveness of training aimed at increasing general practitioners' (GP) work awareness and patients' work-related self-efficacy and quality of life. METHODS: A cluster randomized controlled trial in twenty-six GP practices in the southeast of the Netherlands with 32 participating GPs. GPs working in an intervention group practice received training and GPs working in a control group practice delivered usual care. The training intervention consisted of lectures and workshops aimed at increasing GPs' work awareness and more proactive counseling for patients with work-related problems (WRP). Subjects were working age patients with paid work for at least 12 h per week, who visited one of the participating GPs during the study period. As outcome measures we used the Return to Work Self Efficacy scale to assess patients' work-related self-efficacy and the Euroquol to assess quality of life. We also measured health care costs and productivity costs. With a 4-item questionnaire we asked patients to assess their GPs' work awareness. Data were collected at baseline, after 6 and 12 months. RESULTS: Data of 280 patients could be analyzed. The patient related outcomes did not improve after GP training. The change in GP work awareness and the overall mean cost difference (of €770) in favor of the intervention group were not significant. CONCLUSIONS: The training intervention presented in this paper was not cost-effective. Training which is further personalized and targeted at high risk groups with respect to WRP, is more likely to be cost effective.

The Effectiveness of an Intervention to Enhance Cooperation Between Sick-Listed Employees and Their Supervisors (COSS).

Introduction Early return-to-work (RTW) after sick leave is considered to support employees' quality of life. Successful RTW requires adequate cooperation between absent employees and their supervisors. This study assesses the effectiveness of an intervention for COoperation regarding RTW between Sick-listed employees and their Supervisors (COSS; i.e. 'conversation roadmap', monitoring of cooperation and, if necessary, extra occupational physician support). Methods In this field study, employees on sick leave for 2-10 weeks, aged 18 up to and including 60, and performing paid labour for at least 12 h per week were included. Terminally ill were excluded. Multivariate regression (correcting for baseline quality of life) was used to compare 6-months follow up data regarding quality of life between the groups. Using Cox regression analyses, time until first-, full-, and sustainable RTW was compared between groups. Results In total 64 employees received COSS or common practice. No significant group differences were found regarding all study outcomes. The COSS group had a higher chance of work resumption than the common practice group. The hazard ratio was 1.39 for first RTW (95 % CI 0.81-2.37), 1.12 for full RTW (95 % CI 0.65-1.93) and 1.10 for sustainable RTW (95 % CI 0.63-1.95). Conclusions COSS has no significant effects. Yet, the results regarding work resumption show a tendency towards effectiveness. Therefore, COSS can be further developed and applied in practice. Researchers should try to prevent some limitations of the present study in future research, for instance by finding a more common research setting.

Sustainable employability in shiftwork: related to types of work schedule rather than age.

PURPOSE: There is scarce research on age and sustainable employability of nurses working in various types of work schedules. Earlier research showed that nurses working in work schedules differ regarding age. Different operationalisations of age might explain variations in sustainable employability. Therefore, the aim of this study was to investigate how nurses working in various types of work schedule differ regarding sustainable employability, and the role that age plays in these differences. Age was defined as chronological age, organisational age, life-span age, and functional age. METHOD: Questionnaires were distributed to 974 Dutch nurses in residential elder care (response rate 51 %) with questions about the type of work schedule, aspects of sustainable employability, various operationalisations of age, and registered sickness absence data were used. RESULTS: Nurses working in various types of work schedules differed regarding aspects of sustainable employability, also when operationalisations of age were added. The 'life-span age' was directly related to aspects of sustainable employability. Statistically, work ability and job satisfaction were only explained by varying operationalisations of age. CONCLUSIONS: Nurses' sustainable employability appeared to be mainly related to differences between the types of work schedule rather than age. Fixed early shifts are characterised by the most positive aspects of sustainable employability, and three rotating schedules score worst. To improve sustainable employability, organisations should implement a system in which nurses with different types of work schedule are monitored in combination with their life-span perspective.

Quality appraisal of generic self-reported instruments measuring health-related productivity changes: a systematic review.

BACKGROUND: Health impairments can result in disability and changed work productivity imposing considerable costs for the employee, employer and society as a whole. A large number of instruments exist to measure health-related productivity changes; however their methodological quality remains unclear. This systematic review critically appraised the measurement properties in generic self-reported instruments that measure health-related productivity changes to recommend appropriate instruments for use in occupational and economic health practice. METHODS: PubMed, PsycINFO, Econlit and Embase were systematically searched for studies whereof: (i) instruments measured health-related productivity changes; (ii) the aim was to evaluate instrument measurement properties; (iii) instruments were generic; (iv) ratings were self-reported; (v) full-texts were available. Next, methodological quality appraisal was based on COSMIN elements: (i) internal consistency; (ii) reliability; (iii) measurement error; (iv) content validity; (v) structural validity; (vi) hypotheses testing; (vii) cross-cultural validity; (viii) criterion validity; and (ix) responsiveness. Recommendations are based on evidence syntheses. RESULTS: This review included 25 articles assessing the reliability, validity and responsiveness of 15 different generic self-reported instruments measuring health-related productivity changes. Most studies evaluated criterion validity, none evaluated cross-cultural validity and information on measurement error is lacking. The Work Limitation Questionnaire (WLQ) was most frequently evaluated with moderate respectively strong positive evidence for content and structural validity and negative evidence for reliability, hypothesis testing and responsiveness. Less frequently evaluated, the Stanford Presenteeism Scale (SPS) showed strong positive evidence for internal consistency and structural validity, and moderate positive evidence for hypotheses testing and criterion validity. The Productivity and Disease Questionnaire (PRODISQ) yielded strong positive evidence for content validity, evidence for other properties is lacking. The other instruments resulted in mostly fair-to-poor quality ratings with limited evidence. CONCLUSIONS: Decisions based on the content of the instrument, usage purpose, target country and population, and available evidence are recommended. Until high-quality studies are in place to accurately assess the measurement properties of the currently available instruments, the WLQ and, in a Dutch context, the PRODISQ are cautiously preferred based on its strong positive evidence for content validity. Based on its strong positive evidence for internal consistency and structural validity, the SPS is cautiously recommended.

Factors affecting the acceptance of people with disabilities at work: a literature review.

PURPOSE: A lack of social acceptance by non-disabled co-workers is often the reason why employees with disabilities fail to stay in regular organizations for sustained periods. The aim of the study is to present a coherent review of the extant literature on factors affecting the acceptance of people with disabilities in regular employment. METHOD: We conducted a search of the electronic databases PsychINFO and Web of Science (period: 1996-2011) supplemented with a search for additional relevant articles by means of cross-referencing. In total 48 articles were selected, coded and analyzed by three coders into three overarching themes. RESULTS: The analysis of included articles shows that the acceptance of employees with disabilities is influenced by three main variable groups: characteristics of co-workers, of the persons with disabilities and of the employers/organizations. Most studies present factors that influence co-workers' or employers' attitudes toward employees with disabilities such as demographic variables. CONCLUSION: Although, recent research has started to accumulate findings on factors that affect the acceptance of employees with disabilities, many gaps remain in the understanding of the concept of acceptance and its relation to the employment of people with disabilities.

Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: the CASE-study.

BACKGROUND: In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so. METHODS/DESIGN: Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective. DISCUSSION: The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step. TRIAL REGISTRATION: Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (NTR2886), Health and Motion (NTR3111), Guidance to Excel in Return to Work (NTR3151), Care for Companies/Second Care (NTR3136).

Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review.

INTRODUCTION: In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee's health and participation in labour. METHODS: We performed a keyword search (systematic literature review) in seven databases (period: 1994-2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. RESULTS: Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. CONCLUSIONS: Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.

The 'empowered client' in vocational rehabilitation: the excluding impact of inclusive strategies.

In vocational rehabilitation, empowerment is understood as the notion that people should make an active, autonomous choice to find their way back to the labour process. Following this line of reasoning, the concept of empowerment implicitly points to a specific kind of activation strategy, namely labour participation. This activation approach has received criticism for being paternalistic, disciplining and having a one-sided orientation on labour participation. Although we share this theoretical criticism, we want to go beyond it by paying attention to the practical consequences of understanding empowerment as an activation strategy. Inspired by the field of Science and Technology Studies, we will explore the meaning of empowerment and activation in concrete practices of vocational rehabilitation in the Netherlands. Our analysis is based on the narratives of people with a work disability about their lives and the vocational rehabilitation programmes they participated in. We present five illustrative cases that how empowerment is 'done' in the practice of vocational rehabilitation and its unintended effects. Our analysis demonstrates that activation strategies seem to be caught in a paradox: instead of including people in society, they have excluding consequences. Vocational rehabilitation professionals can go beyond this paradox by learning from the ways in which empowerment is 'done' by clients in vocational rehabilitation programmes.

Determinants of regional differences in sick leave duration for homogeneous groups in The Netherlands: their implications for social security policy-making.

OBJECTIVES: Regional differences in sick leave duration determinants were studied between in age and profession homogeneous groups in different regions in The Netherlands, i.e. Utrecht and Southern Limburg, in order to find any effects of socio-cultural factors. MATERIAL AND METHODS: 137 participants in Utrecht and Southern Limburg were interviewed. Data of sick leave duration were obtained from the social fund. RESULTS: A statistical comparison of sick leave duration figures showed that, in Southern Limburg, determinants of 'health status' (questions about perceived health and burnout due to work) and 'individual characteristics and circumstances' (age, gender and satisfaction with private circumstances) were associated with sick leave duration and, in Utrecht, the 'work contents' determinant autonomy. CONCLUSIONS: In the regions studied, different determinants appeared to be associated with sick leave duration and for some of them the European integration was assumed to have a lasting effect. Nationwide policy interventions to reduce sick leave duration should take into account the existence of regional differences in determinants predicting sick leave duration and the potential effects of different socio-cultural characteristics on laying claim to social security.

Conditions for successfully implementing resident-oriented care in nursing homes.

This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

On regional differences in determinants of sick leave frequency for cleaning workers in two regions of the Netherlands: a comparative study.

OBJECTIVES: To explore regional differences in the effects of the sick leave frequency determinants between two homogeneous groups of workers from two comparable socio-economic regions in the Netherlands, namely Utrecht and South Limburg. MATERIALS AND METHODS: Data on sick leave frequency for 137 cleaning workers in the regions of Utrecht (mean sick leave frequency: 0.89 spells) and South Limburg (mean sick leave frequency: 1.66 spells) were obtained from a Dutch social fund, and the data regarding their job, and health-related and individual characteristics were elicited by an interview. RESULTS: A statistical analysis of the sick leave frequency in the two regions showed little differences, except for the determinant 'perceived physical workload' which was associated with the sick leave frequency in South Limburg but not in Utrecht. CONCLUSION: A regional difference in the sick leave frequency was noted with respect to 'perceived physical workload' as the study parameter. This would indicate that the findings of our earlier studies performed in the nineties of the last century. are still relevant. In further research, the principles of the new certification system on sick leave frequency should also be considered, as the previous uniform statutory compensation system has been terminated.

A literature review on sick leave determinants (1984-2004).

OBJECTIVES: A literature review for the years 1984-2004 was performed to identify the determinants of the sick leave frequency and duration over that period and to establish the continuity in the character of those determinants. MATERIALS AND METHODS: The review referred to national and international studies on the determinants of the frequency and duration of sick leave. RESULTS: The review presented a highly consistent picture of the factors determining sick leave frequency and duration. CONCLUSION: Over the study period, the frequency and duration of sick leave were determined by a broad range of factors, a substantial number of which had a similar influence on both the study parameters.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

BACKGROUND: In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. OBJECTIVES: The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). DESIGN: A non-equivalent pre-test/post-test control group design was used in this study. SETTINGS AND PARTICIPANTS: Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. METHOD: Data were selected by means of written questionnaires. RESULTS: The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. CONCLUSIONS: The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

On regional differences in sick leave: the role of work, individual and health characteristics and socio-cultural environment.

OBJECTIVES: Regional differences in sick leave frequency and duration determinants were studied between different professions (sale and cleaning) in different regions in the Netherlands (Utrecht and South Limburg) and the influence of socio-cultural factors on those determinants was explored. MATERIALS AND METHODS: Employees in Utrecht and South Limburg were interviewed on work, individual and health characteristics. Sick leave data were obtained from the social fund. RESULTS: A statistic comparison of sick leave frequency and duration figures between the two professions in the two regions showed that for a part similar, and for another part different determinants were associated with sick leave. CONCLUSION: In Utrecht, socio-cultural influence was assumed for the perception of autonomy and in South Limburg for health complaints. As a consequence, nationwide interventions to reduce sick leave should take into account the potential effects of sociocultural factors on the type of sick leave determinants that predict sick leave per region.

Gender differences in return to work patterns among sickness absentees and their associations with health: a prospective cohort study in The Netherlands.

This article describes (i) gender differences in initial return to work (RTW) and lasting return to work (LRTW); (ii) health characteristics that predicted the observed gender differences in LRTW; and (iii) associations between health characteristics and (L)RTW in men and women separately. A 13-month prospective cohort study was performed with 119 employees (54 women and 65 men) who had reported sick for more than 1 month because of mental or musculoskeletal complaints. These employees were interviewed bimonthly about their work status and health. The health characteristics included were self-rated health, the reason for reporting sick, the presence of at least one long-term disease, early improvement in health and a change in diagnosis. Cox regression analyses on the time to (L)RTW were performed. No gender differences were found regarding RTW. Women, however, did report a longer time to LRTW than men. This was predicted by their reason for reporting sick, the presence of at least one long-term disease, lack of early improvement in health and change in diagnosis. Women who experienced no early improvement and/or whose diagnosis changed during their sickness absence had lower chances of attaining a LRTW than other women. Men who were absent owing to mental complaints were less likely to RTW than men with musculoskeletal complaints. Men who had at least one long-term disease were also less likely to RTW than men who had no long-term diseases. The findings showed a delayed LRTW for women when compared with men, as predicted by health characteristics. The health characteristics, however, that predicted LRTW in women differed from those that predicted LRTW in men. Clearly, the findings support a gender-specific approach to sickness absence guidance. The results also suggest that women are misdiagnosed more often than men. This requires further investigation.

The influence of sick leave frequency determinants on homogeneous groups in two socio-economically comparable, but socio-culturally different regions in The Netherlands.

OBJECTIVES: The aim of this study was to explore the influence of sick leave frequency determinants on in terms of age and profession homogeneous groups in two socio-economically comparable, but socio-culturally different regions in The Netherlands, i.e., Utrecht (mean frequency 1.10 spells) and South Limburg (mean frequency 1.92 spells). In addition, to get an idea of the study's topical interest, a literature review on sick leave frequency determinants covering the past few decades was performed. MATERIAL AND METHODS: 184 participants in the Utrecht and South Limburg regions were interviewed on work, individual and health characteristics. Sick leave frequency data were obtained from a social fund. For the literature review (inter)national scientific journals, academic theses and Medline were consulted. RESULTS: A comparison of sick leave frequency in the two regions showed that, in South Limburg, the determinants called 'opinion on social-medical support during sick leave', 'type of appointment' and 'annual number of visits (family doctor)' were associated with sick leave frequency whereas this was not the case in Utrecht. The literature review presented a highly consistent picture of determinants of sick leave frequency over the last few decades. CONCLUSIONS: In the two regions studied, different determinants appeared to be associated with sick leave frequency. This phenomenon is attributed to the different socio-cultural characters of the regions. As per region different determinants appeared to be associated with sick leave frequency, nationwide interventions to reduce sick leave frequency should take into account the potential influence of regional differences in determinants that predict sick leave frequency. Sick leave frequency determinants have not changed in the past few decades. Although the study was performed in the nineties, its results are still relevant.

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation.

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

Factors associated with participation on the competitive labour market of people with visual impairments in The Netherlands.

BACKGROUND: Worldwide, the employment rate of people with visual impairments (PVIs) is lower than that of the general working-age population. To improve the employment rate of this group, there is a need for knowledge about differences in modifiable factors between working and non-working PVIs. OBJECTIVE: To identify modifiable factors associated with participation on the competitive labour market of PVIs. Based on the findings, we aim to develop an individual assessment instrument for determining the odds of labour market success of PVIs. METHODS: Data were collected among 299 PVIs by means of a cross-sectional telephone survey based on existing (validated) and self-developed scales and items. Logistic regression analysis was used to find the strongest predictors of the dichotomous outcome of 'having paid work on the competitive labour market' (yes/no). RESULTS: We found three personal non-modifiable factors (level of education, comorbidity, level of visual impairment) and three modifiable factors (mobility, acceptance and optimism) to be significantly (p <  0.05) associated with having paid work. CONCLUSIONS: The factors of optimism, acceptance and mobility should be included in an individual assessment instrument which can provide PVIs and their job coaches with good starting points for improving the labour market situation of the PVIs.

Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis.

OBJECTIVES: Evaluating the cost effectiveness and cost utility of an integrated care intervention and participatory workplace intervention for workers with rheumatoid arthritis (RA) to improve their work productivity. METHODS: Twelve month follow-up economic evaluation alongside a randomized controlled trial (RCT) within specialized rheumatology treatment centers. Adults diagnosed with RA between 18-64 years, in a paid job for at least eight hours per week, experiencing minor difficulties in work functioning were randomized to the intervention (n = 75) or the care-as-usual (CAU) group (n = 75). Effect outcomes were productivity and quality of life (QALYs). Costs associated with healthcare, patient and family, productivity, and intervention were calculated from a societal perspective. Cost effectiveness and cost utility were assessed to indicate the incremental costs and benefits per additional unit of effect. Subgroup and sensitivity analyses evaluated the robustness of the findings. RESULTS: At-work productivity loss was about 4.6 hours in the intervention group and 3.5 hours in the care as usual (CAU) group per two weeks. Differences in QALY were negligible; 0.77 for the CAU group and 0.74 for the intervention group. In total, average costs after twelve months follow-up were highest in the intervention group (€7,437.76) compared to the CAU group (€5,758.23). The cost-effectiveness and cost-utility analyses show that the intervention was less effective and (often) more expensive when compared to CAU. Sensitivity analyses supported these findings. DISCUSSION: The integrated care intervention and participatory workplace intervention for workers with RA provides gains neither in productivity at the workplace nor in quality of life. These results do not justify the additional costs.

A process evaluation of a return-to-work intervention to improve Cooperation between Sick-listed employees and their Supervisors (COSS).

BACKGROUND: This is a process evaluation of an intervention to improve Cooperation regarding return-to-work (RTW) between sick-listed employees and their supervisors (COSS, which consists of a conversation roadmap, monitoring of cooperation using questionnaires and, if necessary, extra support by an occupational physician (OP). OBJECTIVE: Objectives were to study (1) the adoption of COSS by a banking organization and (2) its implementation among individual employees, supervisors and OPs. METHODS: We used quantitative data (online questionnaire, project administration, conversation minutes, emails) and qualitative data (semi-structured interviews). We analyzed quantitative data descriptively (by calculating sum scores, percentages, mean scores and standard deviations). The coding system to analyze the qualitative data was data-driven. RESULTS: The organization's representatives reported positively (e.g. fit with existing policy) and negatively (e.g. high intensity) about COSS. At least one OP (out of five) used the monitoring information. Project administration data show a modest reach of COSS among employees and supervisors. The roadmap was used by a minority (35% of the employees and 25% of the supervisors). Relatively many (40% of the employees and 100% of the supervisors who used COSS to evaluate conversations) were satisfied with COSS as a  tool to evaluate conversations with the employee/supervisor afterwards. Interview results indicate that the roadmap was considered useful in specific situations (e.g. psychological complaints). All employees and supervisors participated in the monitoring. The majority of the responding employees and supervisors received OP support and was satisfied about this support. CONCLUSIONS: Despite the good adoption of COSS by the organisation, it was only partially implemented by professionals, employees and supervisors. We hypothesize that our implementation approach did not fit completely with the culture at the bank. Also, the results illustrate the need for other intervention methods for improving cooperation between employees and supervisors and a more specific target population.