Does enhanced information exchange between social insurance physicians and occupational physicians improve patient work resumption? A controlled intervention study

Anna Katharina (Katrien) Mortelmans ¹, Peter Donceel ^1*, Dirk Lahaye ¹ and Simon Bulterys ²

¹ Katholieke Universiteit Leuven, Belgium
² Occupational Health Services IDEWE, Belgium

^* To whom correspondence should be addressed. E-mail: peter.donceel{at}med.kuleuven.be.

Accepted 10 February 2006

Abstract

Objectives Patient work resumption after sickness absence varies even among patients with similar pathologies and characteristics. Explanations remain uncertain. One newly investigated field is information asymmetry, a situation in which critical information is not appropriately exchanged between stakeholders in disability management. We hypothesized that information asymmetry between social insurance physicians and occupational physicians prolong sickness absence. The study objective was to assess the influence of enhanced information exchange between these physicians on patient outcome.

Methods We conducted a non-randomized controlled intervention study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. The patients inclusion criteria were: employee, age 18- 50, and sub-acute (more than one month) sickness absence. Pregnancy related sicknesses were excluded. The intervention was a structured information exchange (through the use of a communication form) between the patients social insurance physician and occupational physician. The intervention started when the patients sickness absence reached the sub-acute stage, and ended when the sickness absence benefit was ceased or the duration exceeded one-year. The primary outcome measure was the sickness absence benefit status of the patient assessed one-year after benefit onset.

Results 1883 patients were asked to enrol in the study, 1564 (84%) participated. 505 (32%) of 1564 patients were assigned to the intervention group and 1059 (68%) to the control group. 1553 (99%) of 1564 patients completed the study. In the intervention group, 86% received no sickness absence benefit at the end of the study, versus 84% in the control group (p=0,41, CI: 0,91-1,15). No significant differences in other outcome parameters were obtained.

Conclusions Information exchange between physicians may not be enough to influence work resumption among patients on sickness absence. Further research on stakeholders information asymmetry and its effect on the outcome of patients are necessary. The complexity of information asymmetry in disability management cannot be underestimated.

Keywords: disability, physicians, sick leave

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