Return to work after an acute coronary syndrome: patients' perspective.

OBJECTIVES: To describe the time perspective of return to work and the factors that facilitate and hinder return to work in a group of survivors of acute coronary syndrome (ACS). METHODS: Retrospective semi-structured telephone survey 2 to 3 years after hospitalization with 84 employed Dutch ACS-patients from one academic medical hospital. RESULTS: Fifty-eight percent of patients returned to work within 3 months, whereas at least 88% returned to work once within 2 years. Two years after hospitalization, 12% of ACS patients had not returned to work at all, and 24% were working, but not at pre-ACS levels. For all ACS-patients, the most mentioned categories of facilitating factors to return to work were having no complaints and not having signs or symptoms of heart disease. Physical incapacity, co-morbidity, and mental incapacity were the top 3 categories of hindering factors against returning to work. CONCLUSION: Within 2 years, 36% of the patients had not returned to work at their pre-ACS levels. Disease factors, functional capacity, environmental factors, and personal factors were listed as affecting subjects' work ability level.

Facilitators and Barriers in the Use of a Checklist by Insurance Physicians during Work Ability Assessments in Depressive Disorder.

OBJECTIVES: Depressive disorder (DD) is a complex disease, and the assessment of work ability in patients with DD is also complicated. The checklist depression (CDp) has recently been developed to support such work ability assessments and has been recommended for implementation in insurance medicine, starting with an analysis of the organisational and social contexts. The aim of this study was to identify the potential facilitators and barriers in the use of the CDp by insurance physicians (IPs) during work ability assessments of employees on sick leave due to DD. METHODS: A qualitative research was conducted based on semi-structured interviews. The participants were IPs with at least one year of work experience in performing work ability assessments. The interviews were audiotaped, transcribed and analysed qualitatively. RESULTS: Ten IPs (7 males, 3 females; mean 53 years) were interviewed. Important facilitators, which emerged for use of the CDp, were an oral introduction for colleagues and staff, support from management, valuing the increased transparency in work ability assessments with using the CDp, having adequate time for assessments as well as modification of the appearance (colour, plasticised form) and content (clarifying aspects of the examples) of the assessment tool. The fear of the loss of autonomy, lack of added value of the CDp, high workload, inadequate instructions and lack of time were mentioned as barriers. CONCLUSION: Adequate introduction to the use of CDp and the fear of the loss of autonomy of IPs need special attention in planning its implementation.

Work ability in sick-listed patients with major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is often a chronic relapsing disease resulting in work disability. For evaluation purposes a practical set of aspects of work ability would be helpful. AIM: To identify the most important disease-specific aspects of work ability for sick-listed employees with MDD. METHODS: An expert brainstorming session identified the specific abilities that were thought to be associated with work ability in sick-listed employees with MDD and that could also be associated with the items of the Hamilton Rating scale for Depression. Sixty-four insurance physicians (IPs) were then selected to participate in a two-round Delphi study. The aim of the first Delphi round was to identify the abilities that were thought to be important by at least 80% of the IPs. In the second Delphi round, the abilities ranked in the top 10 by at least 55% of the IPs were identified as being the most important items. RESULTS: Sixty-one IPs participated in the two Delphi rounds. The most important abilities to be evaluated in work ability evaluation for sick-listed employees with MDD were to take notice, to sustain attention, to focus attention, to complete operations, to think in a goal-directed manner, to remember, to perform routine operations, to undertake structured work activities, to recall and to perform autonomously. CONCLUSION: According to 55% of the IPs, there were 10 important aspects of work ability that have to be considered in a work ability evaluation of sick-listed employees with MDD.

Work-ability evaluation: a piece of cake or a hard nut to crack?

PURPOSE: To describe what aspects, categorized according to the ICF model, insurance physicians (IPs) take into account in assessing short- and long-term work-ability. METHOD: An interview study on a random sample of 60 IPs of the Dutch National Institute for Employee Benefit Schemes, stratified by region and years of experience. RESULTS: In determining work-ability, a wide range of aspects were used. In the case of musculoskeletal disease, 75% of the IPs considered the 'function and structures' component important. With psychiatric and other diseases, however, the 'participation factor' component was considered important by 85 and 80%, respectively. Aspects relating to the 'environmental factor' and 'personal factor' components were mentioned as important by fewer than 25%. In assessing the short- and long-term prognosis of work-ability, the 'disease or disorder' component was primarily used with a rate of over 75%. CONCLUSIONS: In determining work-ability, insurance physicians predominantly consider aspects relating to the 'functions and structures' and 'participation' components of the ICF model important. The 'environmental factor' and 'personal factor' components were not often mentioned. In assessing the short- and long-term prognosis of work-ability, the 'disease or disorder' component was predominantly used. It can be argued that 'environmental factors' and 'personal factors' should also more often be used in assessing work-ability.