Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems:Analysis of a peer group training

Background Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training was developed for Dutch occupational physicians (OPs) focusing on identifying barriers and addressing them. The aim of this study was to provide an overview of the barriers that OPs perceived in adhering to the Dutch guideline on mental health problems as well as their solutions to overcome them. Methods A qualitative study was conducted using data from the peer group training. Thirty-two (6 groups of 4 to 6) OPs received a multiple-session interactive training over the course of a year, focusing on identifying and addressing barriers, using a Plan-Do-Check-Act approach. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers with a selection of 50 % (21 out of 42) of the transcripts to identify the perceived barriers and the suggested solutions, using AtlasTi 7.0. Results Knowledge-related barriers were perceived regarding the content of all parts of the guideline. Commonly perceived attitude-related barriers were a lack of self-efficacy to perform certain guideline recommendations and difficulties with changing habits and routines. External barriers that were commonly perceived were work-contextual barriers, such as a lack of time/work pressure, tight contracts between occupational health services (OHSs) and employers, and conflicting policy of and a lack of collaboration with other parties (e.g. employer, other healthcare providers). The most often tested solutions by OPs during the training were sharing information, experiences, tips and tricks and referring to existing tools, or developing new tools to facilitate guideline usage. Conclusions Dutch OPs perceive a range of knowledge-related, attitude-related and external barriers in adhering to the guideline on mental health problems. The tested solutions during the training particularly seemed to focus on knowledge and attitude-related barriers. To optimally implement this or similar mental health guidelines, it may be important to complement guideline training and education of individual or groups of OPs, with interventions that address external barriers such as changing tight contracts, or improving communication and collaboration with other parties. Keywords Mental health, Practice guideline, Occupational medicine, Barriers, Solutions, Implementatio

Effectiveness of an intervention to enhance occupational physicians’ guideline adherence on sickness absence duration in workers with common mental disorders:A cluster-randomized controlled trial

Purpose Evidence-based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration. Notwithstanding that, guideline adherence of occupational physicians (OPs) is limited. Based on the literature on guideline implementation, an intervention was developed that was shown to effectively improve self-reported adherence in OPs. The aim of present study was to evaluate whether this intervention leads to earlier return to work (RTW) in workers with common mental disorders (CMD). Methods In a two-armed cluster randomized controlled trial, 66 OPs were randomized. The trial included 3379 workers, with 1493 in the intervention group and 1886 in the control group. The outcome measures were: time to full RTW, time to first RTW, and total hours of sickness absence. Cox regression analyses and generalized linear mixed model analyses were used for the evaluations. Results The median time to RTW was 154 days among the 3228 workers with CMD. No significant differences occurred in (time to) full RTW between intervention and control group HR 0.96 (95% CI 0.81–1.15) nor for first RTW HR 0.96 (95% CI 0.80–1.15). The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group. Conclusions The intervention to enhance OPs’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs. Possible explanations are the remaining external barriers for guideline use, and that perceived guideline adherence might not represent actual guideline adherence and improved care

Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: Analysis of a peer group training

Background: Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training was developed for Dutch occupational physicians (OPs) focusing on identifying barriers and addressing them. The aim of this study was to provide an overview of the barriers that OPs perceived in adhering to the Dutch guideline on mental health problems as well as their solutions to overcome them. Methods: A qualitative study was conducted using data from the peer group training. Thirty-two (6 groups of 4 to 6) OPs received a multiple-session interactive training over the course of a year, focusing on identifying and addressing barriers, using a Plan-Do-Check-Act approach. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers with a selection of 50 % (21 out of 42) of the transcripts to identify the perceived barriers and the suggested solutions, using AtlasTi 7.0. Results: Knowledge-related barriers were perceived regarding the content of all parts of the guideline. Commonly perceived attitude-related barriers were a lack of self-efficacy to perform certain guideline recommendations and difficulties with changing habits and routines. External barriers that were commonly perceived were work-contextual barriers, such as a lack of time/work pressure, tight contracts between occupational health services (OHSs) and employers, and conflicting policy of and a lack of collaboration with other parties (e.g. employer, other healthcare providers). The most often tested solutions by OPs during the training were sharing information, experiences, tips and tricks and referring to existing tools, or developing new tools to facilitate guideline usage. Conclusions: Dutch OPs perceive a range of knowledge-related, attitude-related and external barriers in adhering to the guideline on mental health problems. The tested solutions during the training particularly seemed to focus on knowledge and attitude-related barriers. To optimally implement this or similar mental health guidelines, it may be important to complement guideline training and education of individual or groups of OPs, with interventions that address external barriers such as changing

Van kleur veranderende kunststoffen: Onder invloed van temperatuur, vocht, UV, ... etc.

Van kleur veranderende kunststoffen zijn kunststoffen die onder invloed van een verandering in de omgeving van kleur veranderen. Er zijn meerdere invloeden bekend, waaronder temperatuur (thermochromatisch), vocht (hydrochromatisch) en uv-straling (fotochromatisch)1. Dit klinkt wellicht futuristisch, maar de technologie bestaat al tientallen jaren. In 1975 brachten twee New Yorkers, Josh Reynolds and Maris Ambats, de mood ring op de markt in Amerika2. De mood ring verandert onder invloed van temperatuur van kleur. Dit is mogelijk door het gebruik van vloeibare kristallen en kwartsstenen. In de jaren 80 van de vorige eeuw introduceerde Mattel de Hotwheels Color Shifters. Hotwheels Color Shifters3 zijn speelgoedautootjes die in warm en koud water van kleur veranderen door leuco kleurstoffen in de lak. In dit document worden verschillende kleurstoffen/pigmenten en de verwerking er van beschreven. Dit document is opgeleverd in het project Innovatief Materialen Platform Twente (IMPT). In dit project heeft het IMPT 75 innovatieve materialen in kaart gebracht.  Met een tiental materialen is toegepast onderzoek gedaan, zodat ondernemers en ontwerpers weten of en hoe zij deze kunnen toepassen

Use of a mental health guideline by occupational physicians and associations with return to work in workers sick-listed due to common mental disorders: A retrospective cohort study

Purpose: The aim of this study was to evaluate (1) whether adherence to the Dutch occupational mental health guideline by occupational physicians was associated with time to return to work in workers sick-listed due to common mental disorders; and (2) whether adherence to specific guideline items was associated with time to return to work. Methods: Twelve performance indicators were developed to assess occupational physicians’ guideline adherence. Medical records of 114 sick-listed workers were audited. Performance indicators were scored as indicating no (0), minimal (1) or adequate adherence (2). Cox regression analysis was used to assess the association between guideline adherence and first or full return to work. Results: Guideline adherence was predominantly minimal on most performance indicators. This low overall adherence was not associated with first return to work (Hazard Ratio 1.07, p = 0.747) or with full return to work (Hazard Ratio 1.25, p = 0.301). Only one performance indicator (regular contact between occupational physician and employer) was significantly associated with earlier full return to work (Hazard Ratio 1.87, p = 0.021). Conclusions: Overall, the guideline adherence of occupational physicians was not related to earlier return to work. However, there was considerable room for improvement in guideline use. Whether this leads to earlier return to work is still an ununanswered question. Implications for Rehabilitation Adherence of occupational physicians to an evidence-based occupational mental health guideline was low. Regular contact between occupational physician and employer was associated with earlier full return to work in workers with common mental disorders. It is important to focus on how implementation problems and barriers for guideline use can be overcome, in order to improve the quality of occupational mental health care and to potentially reduce sickness absence duration in workers with common mental disorders. Keywords: Guideline adherence, mental health problems, occupational health care, practice guideline, sickness absence duratio

Improving occupational physicians' adherence to a practice guideline:Feasibility and impact of a tailored implementation strategy

Background Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs’ barriers were evaluated. Methods OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs’ experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. Results The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). Conclusions The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs’ knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too

Effect of an intervention to enhance guideline adherence of occupational physicians on return-to-work self-efficacy in workers sick-listed with common mental disorders

Background Since a higher level of self-efficacy in common mental disorders is associated with earlier return-to-work (RTW), it is important to know if work related self-efficacy can be increased by occupational health care. The primary aim of this study was to evaluate whether an intervention to enhance guideline adherence of occupational physicians lead to an increase in RTW self-efficacy in workers three months later. The secondary aim was to evaluate whether the intervention modified the association between RTW self-efficacy and return-to-work three months later. Methods A total of 66 occupational physicians participated in the study. They were randomized into two groups; the intervention group received a training, the control group did not. The training aimed to enhance adherence to a mental health guideline that contained strategies that are supposed to enhance RTW self-efficacy. In 128 sick-listed workers guided by these occupational physicians, RTW self-efficacy, RTW, and personal, health-related and work-related variables were measured at baseline and three months later. Generalized linear mixed models analysis and linear mixed models analysis were used for the evaluations. Results In workers whose occupational physicians had received the training RTW self-efficacy increased significantly more than in workers whose occupational physicians had participated in the control group (t = −2.626, p ≤ .05). Higher baseline RTW self-efficacy scores were significantly more often associated with full RTW than with no RTW three months later (OR 2.20, 95 % CI 1.18–4.07), but the intervention did not affect this association. Conclusions This study showed that a training to enhance guideline adherence of occupational physicians leads to increased RTW self-efficacy in workers sick-listed with common mental disorders during the first months of sickness absence in a real-life occupational health care setting. This insight is helpful for optimizing the recovery and RTW process, and for understanding the role of RTW self-efficacy in this process