Samverkan kring patienter med depression, ångest och stressreaktion: samordnare på vårdcentralen och samtal på arbetsplatsen - CO-WORK-CARE - en klusterrandomiserad studie
Samverkan kring patienter med depression, ångest och stressreaktion: samordnare på vårdcentralen och samtal på arbetsplatsen - CO-WORK-CARE - en klusterrandomiserad studie
Project number : 248501
Created by: Cecilia Björkelund, 2018-05-17
Last revised by: Cecilia Björkelund, 2018-11-21
Project created in: FoU i Västra Götalandsregionen

PublishedPublished

1. Översiktlig projektbeskrivning

Engelsk titel

Cooperation for patients with common mental disorders: care manager function at the primary care centre and intervention at the workplace – CO-WORK-CARE; a pragmatic randomised controlled trial

Populärvetenskaplig sammanfattning av projektet

Sjukfrånvaron ökar åter i Sverige. Det är framför allt inom området psykisk ohälsa som ökningen sker och som

nu är den vanligaste enskilda sjukskrivningsorsaken. Primärvården är den verksamhet där den största andelen

individer med psykisk ohälsa söker och också får vård. En vårdsamordnarfunktion på vårdcentralen, där

vårdsamordnaren ansvarar för stöd och nära kontakt med patienter med psykisk ohälsa och kan verka som

"spindeln i nätet" och kombinera patientstödet med andra åtgärder, har i internationella studier visats ha goda

effekter vad gäller depressionsförlopp och återgång till arbete. I Västra Götalandsregionen har implementering

startats för ett införande av vårdsamordnarfunktion för psykisk ohälsa på vårdcentral, och funktionen har i en

samtidig genomförd vetenskaplig utvärdering visats ha goda effekter även i svensk primärvård vad gäller

minskade depressionssymtom, tillfrisknande från depression och ökad livskvalitet för individen. Även

sjukskrivningstiden har kortats för individer som fått vårdsamordnarkontakt utöver sedvanlig behandling

jämfört med för de individer som fått sedvanlig behandling utan vårdsamordnarkontakt.

Denna studie gäller hela gruppen patienter med depression, ångestsyndrom och stressrelaterad psykisk ohälsa i primärvård och 

syftar till att utvärdera om ett konvergenssamtal under sjukskrivningsperioden mellan den

anställde och arbetsgivaren, där vårdcentralens rehabiliteringskoordinator är samtalsledare och initiativtagare,

utöver vårdsamordnarkontakten, leder till kortare sjukskrivningstid jämfört med de individer som endast har

vårdsamordnarkontakt under sjukskrivningen. Denna typ av strukturerad samverkan mellan sjukvården och

arbetsgivaren kan bli ett effektivt medel att få till stånd närmare samarbete mellan vårdcentral, individ och

arbetsgivare utan stor resursåtgång. En hälsoekonomisk studie planeras ske parallellt med interventionsstudien

för att beräkna om denna typ av insatser för personer sjukskrivna för depression, ångest och stressreaktioner

också är effektiva sett ur hälso-och sjukvårdens och samhällets synvinkel.

Vetenskaplig sammanfattning av projektet

The Care Manager function has not been scientifically tested in the Swedish primary care, and is therefore

defined by the Swedish Agency for Health Technology Assessment (SBU) as a knowledge gap in health care

(9). In the Region Västra Götaland an implementation of the Care Manager function at interested PCCs has

been going on since 2015. The first part of the implementation was done as a scientific randomized controlled

trial, in which 11 PCCs have introduced a Care Manager function and 12 PCCs have been control centres

(ClinicalTrials.gov Identifier: NCT02378272 Care Manager - Coordinating Care for Person Centered

Management of Depression in Primary Care - PRIM-CARE). The randomized controlled trial (RCT) is

aimed to study the effects of a care manager function on depression, quality of life and function in the Swedish

primary care context, and also if this leads to the prevention of sickness and disability, and helps reduce the

frequency of sick leave and long-term sick leave for individuals with mental illness.  Data from 6-months follow up shows that 

there is a significant difference between intervention and control group in reduction of symptoms of depression, and remission frequency is significantly higher in the group who had Care Manager contact during the 3 months depression period (61% and 47%,

respectively, p <0.01). Return to work during the  first 3 months is significantly higher in the intervention group with care manager contact..

We now want to test if a cooperation model between the PCC and work place for an effect in terms of reduced absenteeism and quicker

return to work cab be achieved concerning patients sick-listed for depression, anxiety disorders and/or stress-related mental disorder (Common Mental Disorders, CMD) (11).

 This area of CMD is increasing both in women and men. The rehabilitation course differs between depression disorder, anxiety syndromes and stress-related mental disorder,and as stress-related mental disorder is increasing as cause of sick-leave (by now around 40 % of CMD sickleave

diagnose (12)) the contact and cooperation with the patient must be differentiated and the patient support

adjusted to the patient´s needs. This development of a person-centred support to the patient by the Care

Manager, adjusted to the CMD patient's diverging needs depending on symptoms and diagnose is made in close

collaboration between Primary Care/General Practice, Psychiatry, Social Medicine, Institute of Stress Medicine

and Region Västra Götaland.

Since around 2010 a coordinator function for sick leave, often called Rehab Coordinator, has been developed at

every PCC in the Region Västra Götaland subsidized through the so called “sick-certificate billion”. The Rehab

Coordinator function is a support function for the PCC for effective collaboration in the sick-certification and

rehabilitation process (13). The Rehab Coordinator should also be a support for sick-listed patients in the sick

leave process in medical insurance issues. Further, the Rehab Coordinator should coordinate rehabilitation as

well as be a knowledge broker and adviser, and provide advice in certificate issues and suggestions to the

rehabilitation plan (13). The Rehab Coordinator feature is the collaboration and support for the sick individual.

However, the Rehab Coordinator function has been less well-structured and has varied substantially between

PCCs, mostly depending on the diverging competences of the holder of the function.

As a continuation of the development of the Care Manager function for CMD patients at the PCC, a structured

cooperation between the Care Manager and the Rehab Coordinator, coupled with a more structured function

regarding work place contact for the Rehab Coordinator could be developed. The work place contact should be

in a  primary care adapted form of contact described by Work-Place Dialogue for Return-to-Work (ADA) (14). The theoretical framework

 is that there exists a non-correspondence between the needs, capacity and expectations of the

employee, and the nature of the employee’s work, which impedes return-to-work. ADA is a way to reduce and

overcome the non-correspondence and thus increase return-to-work. The core intervention in ADA is the

convergence dialoge – a dialogue between the employer and employee with the ADA consultant as the guide, to

reach concrete both long-term and short-term solutions. The cooperation between the Care Manager and the

Rehab Coordinator will be based on whether the patient has an ongoing sick leave, the sick leave diagnose, the

individual care plan, which the Care Manager and the patient initially draw up together, and the course of the

CMD. The course of mild/moderate depression disorder and anxiety syndromes that are treated in primary care

is often rather time limited and uniform, while that of stress related mental disorder is more complicated with a

relapsing course and more complicated return-to-work process (15). Consequently, the cooperation between the

Care Manager and the Rehab Coordinator will make it possible to add a person-centred, individualized

management of each patient's return-to-work process. In all patient care, there is also a cooperation with

General Practitioner (GP), therapist, and other competences both via the Care Manager and the Rehab

Coordinator, but the structured Care Manager-Rehab Coordinator cooperation as well as the work place

contact will be the added value in the intervention.

Purpose

The purpose of this study is to evaluate whether a combination of the Care Manager function in cooperation

with a structured workplace intervention by the Rehab Coordinator (CO-WORK-CARE) entails earlier return

to work for individuals on sick leave for depression, anxiety and stress related mental disorder, compared with

individuals who have only received the structured Care Manager function and no structured convergence

dialogue workplace intervention.

The research question is: Does a combination of Care Manager function and Rehab Coordinator workplace

intervention (CO-WORK-CARE) give earlier return to work for individuals on sick leave for depression, anxiety

and stress related mental disorder, compared with individuals who have only received the structured Care

Manager contact?

and

Is intervention at the workplace in model CO-WORK-CARE for individuals on sick leave for depression,

anxiety and stress related mental disorder cost-effective compared to Care Manager care only with no

structured workplace intervention?

The hypothesis is, that a combination of Care Manager function and Rehab Coordinator workplace intervention

gives earlier return to work for individuals on sick leave for depression, anxiety and stress related mental

disorder, compared with individuals who have only received the structured Care Manager contact, and that it is

cost-effective according to commonly employed willingness-to-pay-thresholds.

References:

1. Sjukfrånvarons utveckling. Socialförsäkringsrapport 2016:7.

https://www.forsakringskassan.se/wps/wcm/connect/a2001891-5c47-4b8a-b47b-

64dfbbd48555/socialforsakringsrapport_2016_07.pdf?MOD=AJPERES

2. SBU. Behandling av depressionssjukdomar - en systematisk litteraturöversikt. Rapport 166. 2004:1

3. Nationella riktlinjer för depression och ångest. Socialstyrelsen, Stockholm 2010.

http://www.socialstyrelsen.se/publikationer2010/2010-3-4

4. WHO methods and data sources for global burden of disease estimates 2000-2011. WHO Geneva nov

2013. http://www.who.int/healthinfo/statistics/GlobalDALYmethods.

5. SBU. Diagnostik och uppföljning av förstämningssyndrom. En systematisk litteraturöversikt. Stockholm:

Statens beredning för medicinsk utvärdering (SBU); 2012. SBU-rapport nr 212.

6. Vingård E. Psykisk ohälsa, arbetsliv och sjukfrånvaro. Forte. www.forte.se.

7. Huffman JC, Niazi SK, Rundell JR, Sharpe M, Katon WJ. Essential articles on collaborative care models

for the treatment of psychiatric disorders in medical settings: a publication by the academy of

psychosomatic medicine research and evidence-based practice committee. Psychosomatics.

2014;55(2):109-22

8. Statens Beredning för medicinsk utvärdering. Implementeringsstöd för psykiatrisk evidens i primärvården.

En systematisk litteraturöversikt. Rapport 211. 2012.

9. Huang Y, Wei X, Chen R, Guo A. Collaborative care for patients with depression and diabetes mellitus: a

systematic review and meta-analysis. BMC Psychiatry 2013;13:260.

10. Nieuwenhuijsen K, Faber B, Verbeek JH, et al. Interventions to improve return to work in depressed

people. The Cochrane database of systematic reviews 2014;12:CD006237)

11. Busch H, Bonnevier H, Hagberg J, Lohela Karlsson M, Bodin L, Norlund A, et al. En nationell

utvärdering av rehabiliteringsgarantins effekter på sjukfrånvaro och hälsa. Stockholm: Enheten för

interventions- och implementeringsforskning, Institutet för miljömedicin, Karolinska Institutet; 2011.

12. Sjukfrånvaro i psykiska diagnoser. Socialförsäkringsrapport 2014:14. http://www.forskasverige.se/wpcontent/

uploads/Sjukfranvaro-Psykiska-Diagnoser-2014.pdf

13. Rapport hälso-och sjukvårdens funktion för koordinering, 2015.

http://skl.se/download/18.37b886bd151806866505fda1/1450453221303/Rapport-halso-och-sjukvardensfunktion-

for-koordinering-SKL-2015. pdf

14. Karlson B, Östberg K. ADA ArbetsplatsDialog för Arbetsåtergång. Användarmanual v.1.3. Lund: Avd

för arbets- och miljömedicin. Lunds universitet; 2014.

15. Wiegner L, Hange D, Björkelund C, Ahlborg Jr GSTRONG[. ]Prevalence of perceived stress and associations to

symptoms of exhaustion, depression and anxiety in a working age population seeking primary care - an

observational study. BMC Family Practice 2015 16:38 DOI 10.1186/s12875-015-0252-7.

Typ av projekt

Forskningsprojekt

MeSH-termer för att beskriva typ av studier

checked Hälso- och sjukvårdsundersökningar (Health Care Surveys)
checked Prospektiva studier (Prospective Studies)
checked Randomiserad klinisk prövning (Randomized Controlled Trial)


(Only selected options are displayed. Click here to display all options)

MeSH-termer för att beskriva ämnesområdet

information Added MeSH terms
Mental Disorders
Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.
Health Care Quality, Access, and Evaluation
The concept concerned with all aspects of the quality, accessibility, and appraisal of health care and health care delivery.
Health Care Economics and Organizations
The economic aspects of health care, its planning, and delivery. It includes government agencies and organizations in the private sector.

Projektets delaktighet i utbildning

checked Avhandling


(Only selected options are displayed. Click here to display all options)

Registrering i andra projektdatabaser

ClinicalTrials.gov Identifier: NCT03250026

2. Projektorganisation och finansiering

Arbetsplatser involverade i projektet

information Added workplaces
Landsting - Västra Götalandsregionen - Närhälsan - FoU primärvård - Närhälsan FoU-centrum Göteborg och Södra Bohuslän workplace verified by Västra Götalandsregionen on 2018-02-27
USV-enheten allmänmedicin/primärvård - samverkan Primärvård Västra Götaland och enheten för allmänmedicin Göteborgs Universitet

Coworker

Irene Svenningsson
Distriktssköterska, Närhälsan FoUU-centrum Fyrbodal
Dominique Hange (Andersson-Hange, Andersson)
Specialist i Allmänmedicin, Närhälsan Svenljunga vårdcentral, Närhälsan FoU-centrum Södra Älvsborg, Avdelningen för samhällsmedicin och folkhälsa, Enheten för Allmänmedicin
Lilian Wiegner
Överläkare, Institutet för stressmedicin

3. Processen och projektets redovisning

Hur långt har projektet framskridit?

Rekrytering/datainsamling pågår

Projektstart (när planeringen påbörjas och börjar dokumenteras skriftligt)

2017-07-11

Datum då projektet är slutrapporterat

2022-12-31

Samverkan kring patienter med depression, ångest och stressreaktion: samordnare på vårdcentralen och samtal på arbetsplatsen - CO-WORK-CARE - en klusterrandomiserad studie, from FoU i Sverige
http://www.researchweb.org/is/en/sverige/project/248501