Journal of Occupational Rehabilitation

, Volume 16, Issue 1, pp 38–49 | Cite as

Medical Care of Employees Long-Term Sick Listed Due to Mental Health Problems: A Cohort Study to Describe and Compare the Care of the Occupational Physician and the General Practitioner

  • J. R. Anema
  • K. Jettinghoff
  • I. Houtman
  • C. G. Schoemaker
  • P. C. Buijs
  • R. van den Berg
Article

Objectives: To describe medical management by the general practitioner (GP) and occupational physician (OP) of workers sick listed due to mental health problems, and to determine agreement in diagnosis, main cause of sickness absence and obstacles in return to work. Methods: A cohort of 555 employees being sick listed for 12 to 20 weeks due to mental health problems was recruited and followed for 1 year. These employees were interviewed about their mental health and contacts with GP, OP, other specialists and employer. In addition, the GP and/or the OP of 72 employees were interviewed about the medical diagnosis and management. Results: Most employees sick listed for 12–20 weeks visited their GP and OP. According to the employees most interventions applied by the GP were medical interventions, such as referral of employees and prescription of medical drugs. Working conditions were seldom discussed by the GP and work-related interventions were never applied. Most interventions applied by the OP were work-related interventions and/or contact with the employer. The OP more often talked about working conditions and conflicts. According to the employees, the communication between GP and OP only took place in 8% of the cases. Agreement in the diagnosis, main cause of sickness absence, and obstacles in return to work reported by the GPs and OPs of the same employee was poor. In addition, similarity in reported diagnosis by GP and/or OP and the employees’ scores on valid questionnaires on (mental) health was limited. Conclusions: The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub—optimal medical treatment and return-to-work strategies.

KEY WORDS:

mental disorders occupational physician general practitioner obstacles for return-to-work communication similarity in medical diagnosis: causes of absenteeism 

REFERENCE

  1. 1.
    Einerhand M, van der Stelt H. Growing Disability Rates - The Gender Issue: The Dutch Case in an International Perspective. Int Soc Secur Rev 2005; 58(1): 65–84. http://ssrn.com/abstract=658516.
  2. 2.
    Nieuwenhuijsen K, Verbeek JH, Siemerink JC, Tummers-Nijsen D. Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study. Occup Environ Med 2003; 60(1): i21—i25.PubMedCrossRefGoogle Scholar
  3. 3.
    Ministerie van Sociale Zaken en Werkgelegenheid [Dutch Ministry of Social Affairs and Employment]. Sociale Nota 2000 [Paper on Social Policy 2000]. The Hague: SDU; 1999.Google Scholar
  4. 4.
    Uitvoering Werknemersverzekeringen [Employed Persons’ Insurance Administration Agency]. Ontwikkeling arbeidsongeschiktheid: Jaaroverzicht WAO/WAZ/Wajong 2001 [Currents on work disability: Annual survey Disablement Insurance Act 2001]. Amsterdam: Uitvoering Werknemersverzekeringen; 2002.Google Scholar
  5. 5.
    Commissie Psychische Arbeidsongeschiktheid [Committee for Occupational Disability due to mental health problems]. Leidraad Aanpak verzuim om psychische redenen [Guideline Approaching Absenteeism due to mental health problems]. Commissie Psychische Arbeidsongeschiktheid; 2001.Google Scholar
  6. 6.
    Commissie Psychische Arbeidsongeschiktheid [Committee for Occupational Disability due to mental health problems]. Implementatieplan bij leidraad voor verzuim om psychische redenen [Plan for implementation of the guideline for approaching absenteeism due to mental health problems]. Commissie Psychische Arbeidsongeschiktheid; 2001.Google Scholar
  7. 7.
    Buijs PC, van Vuuren CV, Halewijn IMAJ. Evaluation of OHS consulting to a Dutch non-profit organisation. People at work. Research Report. Supplement to the Scientific Journal of the Finnish Institute of OHS. Helsinki; 1998Google Scholar
  8. 8.
    Bollen SH, van der Klink JJL, Terluin B, Wijers JH. Snel weer aan het werk: De rol van artsen bij de aanpak van verzuim om psychische redenen [Enhanced work resumption: The physicians’ role when approaching absenteeism due to due to mental health problems]. Medisch Contact 2002; 57(11): 420– 422.Google Scholar
  9. 9.
    Anema JR, Buijs PC, van Putten DJ. Samenwerking van de huisarts en bedrijfsarts: Een leidraad voor de praktijk [Co-Operation between general practitioner and occupational physician; A practical guideline]. Medisch Contact 2001; 56(20): 790–793.Google Scholar
  10. 10.
    Buijs P, van Amstel R, van Dijk R. Dutch occupational physicians and general practitioners wish to improve co-operation. Occup Environ Med 1999; 56: 709–713.PubMedCrossRefGoogle Scholar
  11. 11.
    Anema JR, van der Giezen AM, Buijs PC, van Mechelen W. Ineffective disability management by doctors is an obstacle for return to work: A cohort study on low back pain patients sick listed for 3–4 months. Occup Environ Med 2002; 59: 729–733.PubMedCrossRefGoogle Scholar
  12. 12.
    Houtman ILD, Schoemaker CG, Blatter BM, de Vroome EMM, van den Berg R, Bijl RV. Psychische klachten, interventies en werkhervatting: De prognosestudie INVENT [Mental health problems, interventions, and work resumption: The prognoses Study INVENT]. Hoofddorp: TNO Arbeid; 2002.Google Scholar
  13. 13.
    Koeters MWJ, Ormel J. Handleiding general health questionnaire [Instructions for use of the general health questionnaire]. Lisse: Swets & Zeitlinger, 1991.Google Scholar
  14. 14.
    Schauffeli WB, van Dierendonk D. Handleiding UBOS [Instructions for use of the UBOS]. Lisse: Swets & Zeitlinger, 2000.Google Scholar
  15. 15.
    Arrindel W, Ettema J. Instructions for use of the SCL90 (in Dutch). Lisse: Swets & Zeitlinger, 1986.Google Scholar
  16. 16.
    Cohen J, A. coefficient of agreement for nominal scales. Educ. Psychol. Meas 1960; 20: 37–46.CrossRefGoogle Scholar
  17. 17.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.PubMedCrossRefGoogle Scholar
  18. 18.
    Andrea H, Metsemakers JF, Kant IJ, Beurskens AJ, Swaen GM, van Schayck CP. Seeking help in relation to work–visiting the occupational physician or the general practitioner. Occup Med (Lond) 2004; 54: 419– 21.CrossRefGoogle Scholar
  19. 19.
    Hoffman H, Guidotti TL. Basic clinical skills in occupational medicine. Prim Care 1994; 225.Google Scholar
  20. 20.
    Buijs PC (edr). Visie van de Landelijke Huisartsen Vereniging LHV en de Nederlandse Vereniging voor Arbeids- en Bedrijfsgeneeskunde NVAB op de plaats en taak van beide disciplines. Samenwerking en begeleiding van bedrijfsarts en huisarts bij de SMB van werknemers [Vision of the National General Medical Practitioners’ Association and the Dutch Association for Medical Services in Industry on the place and task of both disciplines. Co-Operation and guidance of OP and GP during social medical guidance of employees]. Utrecht: Landelijke Huisartsen Vereniging and Nederlandse Vereniging voor Arbeids- en Bedrijfsgeneeskunde; April 1998.Google Scholar
  21. 21.
    Koninklijke Nederlandsche Maatschappij tot Bevordering der Geneeskunde [Royal Dutch Medical Association]. Taken en samenwerking bij sociaal-medische begeleiding. Curatieve handelingen door de bedrijfsartsen, verzuimbegeleiding door de huisarts. Advies van de Domus-commissie Artsen en Arbeidsongeschiktheid aan het Hoofdbestuur van de KNMG [Tasks and co-operation during social medical guidance. Curative treatments by the OPs, guidance during sickness absence by the GP. Advise of the Domus Commission Physicians and Disability to the Board of directors of the KNMG]. Utrecht: Koninklijke Nederlandsche Maatschappij tot Bevordering der Geneeskunde (KNMG); March 1996.Google Scholar
  22. 22.
    Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work. Evidence review. London: Faculty of Occupational Medicine, 2000.Google Scholar
  23. 23.
    Andrea H, Metsemakers JF, Kant IJ, Beurskens AJ, Swaen GM, van Schayck CP. Seeking help in relation to work–visiting the occupational physician or the general practitioner. Occup Med (Lond) 2004; 54: 419–21.CrossRefGoogle Scholar
  24. 24.
    Morgan DR. The general practitioners’ view. Occup Med 1999; 49: 403–405.CrossRefGoogle Scholar
  25. 25.
    Briner RB. ABC of work related disorders. Absence from work. Br Med J 1996; 313: 874–877.Google Scholar
  26. 26.
    Landelijke Huisartsen Vereniging & Nederlandse Vereniging voor Arbeids- en Bedrijfsgeneeskunde [National General Medical Practitioners’ Association & Dutch Association for Medical Services in Industry]. Convenant van LHV en NVAB inzake de samenwerking bij Sociaal Medische Begeleiding [Agreement between LHV and NVAB concerning the co-operation in Social Medical Counseling]. Utrecht; 1997.Google Scholar
  27. 27.
    Anema JR, Buijs PC, van Amstel RJ, van Putten DJ. Sociaal Medische Begeleiding voor huisarts en bedrijfsarts bij verzuimende werknemers [Social Medical Guidance for general practitioner and occupational physician with respect to workers on sick leave]. De Huisarts/Tijdschr Bedrijfsgeneesk Verzekeringsgeneesk; special edition, March 2002.Google Scholar
  28. 28.
    Hulshof CTJ. Samenwerkingsrichtlijn eerstelijnshandelen bij psychische klachten en arbeid. Evaluatiefase 1: ontwikkeling van een testversie. [Guideline on co-operation between primary treatment in case of mental health problems and work. Evaluation phase 1: development of a test version]. Utrecht/Amsterdam: PARAG/SKB; March 2001. Report No.: PKA 01–303.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • J. R. Anema
    • 1
    • 3
  • K. Jettinghoff
    • 1
  • I. Houtman
    • 1
  • C. G. Schoemaker
    • 2
  • P. C. Buijs
    • 1
  • R. van den Berg
    • 1
  1. 1.Department of Public and Occupational Health and EMGO-Institute Body@Work TNO VUme VU University Medical Center formerly TNO Work and EmploymentHoofddorpThe Netherlands
  2. 2.Netherlands Institute of Mental Health and Addiction (Trimbos Institute)UtrechtThe Netherlands
  3. 3.HoofddropThe Netherlands

Personalised recommendations