Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

Abstract

BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.

A case management occupational health model to facilitate earlier return to work of NHS staff with common mental health disorders: a feasibility study

“…Other studies testing enhanced occupational support have used alternative methods to identify and target sick-listed staff, such as screening routine sickness absence reporting systems followed by direct mail invitations. 23 Although in Kenning et al's study 23 it was noted that identifying prospective participants via this method had generated a smaller than expected number of participants, the overall proportion of eligible sick-listed staff who were screened and consented into their study was larger than in the current study. Furthermore, it is envisaged that adopting a similar method in a future main study will vastly increase the number of prospective participants being screened for eligibility.…”

“…This reflected similar observations in the previous CAMEOS (CAse Management to Enhance Occupational Support) trial. 23 Furthermore, we found that the proportion of sick-listed staff with a CMD who were referred to OH within 8-28 days was smaller than the proportion reported by the OH providers who participated in the survey of care as usual.…”

“…The increase in financial costs required for OH services to deliver enhanced occupational support and case management was also observed in the earlier CAMEOS trial. 23 Notwithstanding the potential resource implications, there is a strong care to be made to NHS trusts' executive boards that any potential increase in costs associated with providing extended OH consultation times could be offset if sick-listed staff are able to RTW sooner than they would have done otherwise.…”

“…In Kenning et al's study, 23 potentially eligible staff who were on sick leave were identified by scanning organisations' sickness absence reporting databases and sending out participant information sheets directly. A similar approach could be readily adopted for a future evaluation of our case management intervention while complying with current common law duty for confidentiality.…”

“…Collaborative care interventions such as case management and interventions focused on work-orientated problem-solving have been widely adopted and adapted for specific health conditions and areas, including occupational rehabilitation. [22][23][24][25][26] In essence, case managers (who are often specially trained, allied health professionals) work collaboratively with patients to address their care and treatment needs, usually within a biopsychosocial framework. In the health-care context, the focus is specifically on the biopsychosocial assessment of needs; co-ordination and engagement of services and support; case review, and follow-up.…”