Enhancing evidence-based advice of occupational health physicians

Abstract

Objective: This study attempted to determine the effectiveness of an intervention to enhance evidence-based advice given by occupational physicians. Methods: Altogether 106 occupational physicians were cluster randomized into 16 groups. The intervention group received a course in evidence-based medicine, followed by a 4-month period of case-method learning sessions in peer groups once every 2 weeks. During these sessions, the participants discussed their patients with respect to sickness absence and the existing evidence for return-to-work prognosis and effective interventions. The participants were assigned to perform a literature search at least once every 4 weeks. The primary outcome measure was the quality of advice based on the correct assessment of prognosis for return to work or the correct choice of return-to-work interventions. Secondary outcome measures were the quality of the searches performed by the intervention group, the use of evidence by all occupational physicians during the intervention period, and the potential predictors for advice quality. Results: Better return-to-work interventions were advised by the intervention group than by the control group after 2 months (88% versus 67%, P=0.01), but the difference had decreased after 4 months (76% versus 62%, not significant). No better assessments of prognosis were found for return to work. Most of the searches had a good quality (83% or 73%), and good searching was a positive predictor for a good choice of advised interventions (P=0.03). Without obligatory searches, no increase in evidence use was found. Conclusion: Evidence-based advice by occupational physicians in sickness absence episodes can be improved with multifaceted intervention. The actual search for evidence is an essential element.