Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

BACKGROUND: Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers through preventing illnesses that cause work disability and early retirement. However, impacting on the trajectory between illness and work disability requires continuity of care and follow up, enabled through identifying patients at risk. We aimed to determine whether a combined educational and electronic reminder system in occupational health care could improve the recording and follow up of primary care visits made by patients at risk of work disability, and whether the system could impact on sickness absence rates. METHODS: This study is a pragmatic, cluster-randomized controlled trial using medical record data. Twenty-two Pihlajalinna Työterveys units were randomized into an intervention group receiving education and electronic reminders or a group receiving usual care through minimization methods. Patient consultation data were extracted from routine Pihlajalinna Työterveys patient registers from 2015 to 2017. In addition, process indicators were collected from the electronic system. Data were cleaned and analysed on an intention-to-treat basis using analysis of covariance. RESULTS: There was no significant difference between intervention and control units in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians’ practice of recording patients’ risk of work disability and work-relatedness of visits following the educational intervention. CONCLUSION: Education with an electronic reminder can change physicians’ practice, but long-term follow up is needed to determine whether this impacts on patients’ sickness absences. TRIAL REGISTRATION: ISRCTN Registry: ISRCTN45728263. Registered on 12 April 2016.