Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM).

BACKGROUND: Norway has prioritized health services according to the principle of "severity of conditions", where waiting time reflects patients' medical urgency. We aim to investigate if the "severity-of-condition" principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients' diagnoses and symptom severity at the start of treatment and the corresponding waiting time. METHODS: The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), together with patients' diagnoses to identify patients' needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times. RESULTS: Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders. CONCLUSION: Overall, patients waited in accordance with the "severity of condition" principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.

What are they returning to? Psychosocial work environment as a predictor of returning to work among employees in treatment for common mental disorders: A prospective observational pre-post study.

INTRODUCTION: Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work. METHODS: At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand-Control-Support model and the Effort-Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses. RESULTS: Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability. DISCUSSION: The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.

Predictors of Return to Work 6 Months After the End of Treatment in Patients with Common Mental Disorders: A Cohort Study.

Purpose Common mental disorders (CMDs) account for a large portion of sickness absence. Even after attending return to work (RTW) interventions, many patients with a CMD remain on sick leave. To identify people at risk of long-term work disability, more needs to be known about factors that predict RTW after treatment. Methods This was a prospective cohort study that followed 106 former patients at an RTW outpatient clinic for CMDs for 6 months after the end of treatment. Changes in work participation and mental health status between the end of treatment and the 6-month follow-up were analysed. Changes in work participation were used to identify patients with successful RTW. Patient characteristics and end-of-treatment measures of mental health status, work ability, generalized self-efficacy and expectations of future work ability, and changes in clinical outcome measures during treatment were included in logistic regression analyses to identify predictors of RTW at the 6-month follow-up. Results In the final model, high occupational status and higher work ability at the end of treatment predicted successful RTW at the 6-month follow-up. Further analyses showed that if the expectancy of future work ability improved or remained positive from before to the end of treatment, this was also strongly associated with RTW at the 6-month follow-up. Conclusions Among patients treated for CMDs, those with a low occupational status and who report lower work ability at the end of treatment are at risk of long-term disability.

Predictors of return to work among patients in treatment for common mental disorders: a pre-post study.

BACKGROUND: Effects of return to work (RTW) interventions vary, and more knowledge is needed about the factors that contribute to RTW. This study investigated changes in work participation and mental health, and predictors of RTW among patients being treated for common mental disorders (CMDs). METHODS: The study was a prospective pre-post study of 164 patients treated at an RTW outpatient clinic for CMDs. Differences between before and after treatment were analysed using paired t tests for continuous variables and marginal homogeneity test for categorical variables. Univariable and multivariable logistic regression analyses were used to identify factors associated with RTW. Baseline data (patient characteristics, clinical status, generalized self-efficacy, expectations of future work ability) and treatment variables were used as independent variables in logistic regressions. Further analysis investigated whether improvements in symptoms, work ability, expectations of future work ability and generalized self-efficacy were associated with RTW. RESULTS: Number of individuals with full work participation increased, and there were improvements in symptoms, work ability and generalized self-efficacy. In the final model for predicting RTW, baseline work ability and expectancy of future work ability, a history of psychiatric treatment and focus on RTW in the treatment predicted RTW. Improvement in expectations of future work ability at post-treatment did also predict RTW. CONCLUSIONS: Assessing work ability and expectations of RTW at the beginning of treatment is recommended to identify patients at risk of long-term sick leave. Individuals with a history of psychiatric treatment are also risking long-term work disability. It is essential that treatment focus not only on symptom-relief, but also on improving work ability and expectations of RTW. An RTW-focused approach in therapy is associated with RTW. TRAIL REGISTRATION: ClinicalTrails.gov ID NCT01181635 . Registered 08/12/2010.

Patient characteristics in a return to work programme for common mental disorders: a cross-sectional study.

BACKGROUND: Mental health problems are a growing cause of sickness absence. There are programmes in many countries to facilitate return to work (RTW) after sickness absence. In Norway, there has been some controversy about patients on sick-leave being prioritized over other patient groups, such as those with more severe diagnoses. However, it is not clear whether patients in RTW programmes actually do differ from patients in regular services. METHODS: This study compared 270 patients treated in an RTW outpatient clinic and 86 patients treated in a regular outpatient clinic, both in specialized mental health care, on patient characteristics, history of treatment and mental health status. Analyses of differences between groups were done by ANOVA tests, chi-square test and logistic regression. RESULTS: Patients in the RTW clinic had lower scores on the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). There was no difference in health-related quality of life. RTW patients were somewhat older and more likely to live in relationships and have children, and they had higher incomes. Work participation, previous psychiatric hospitalization and present diagnosis contributed uniquely to an explanation of which patients were included in the respective clinics. The RTW clinic seems to reach its intended target group. Almost all of the patients in this group participated in the work arena, and their psychopathologies were clearly dominated by common mental disorders. Most RTW patients' general practitioners had followed them fairly closely in the year before referral, suggesting previous attempts at treatment in primary care settings. CONCLUSIONS: Relative to outpatients in a specialized mental health care setting, RTW patients had lower symptoms, but still in the same moderate range of severity. They suffered the same reduction in quality of life. Almost all of the RTW patients were diagnosed with illnesses that can be treated effectively, about half of them had recurring mental health problems and many of them had been treated in primary care settings before referral. These findings indicate that this group has significant health problems that can benefit from treatment in specialized health care settings.

Sickness absence and presence among employees in treatment for common mental disorders.

PURPOSE: Common mental disorders are a major cause of long-term sickness absence and a reason for disability benefits, although many people with these disorders remain employed. Therefore, it is important to prevent them from taking sick leave or relying on disability benefits. Consequently, we wished to identify the factors associated with sickness presence among patients undergoing treatment. METHOD: Participants were recruited from patients who met for their first session at a Return to Work clinic. A total of 251 patients completed a questionnaire that included questions on background information, mental health and functioning, and psychosocial work factors. Of these, 49% were fully working, 21.9% were partially working, and 29.1% were on full sickness absence. RESULTS: Fully working patients had fewer symptoms, functioned better, and experienced greater well-being than patients wholly on sick leave. They also experienced work as less demanding, were more appreciative, and had more employment security and autonomy. They reported symptoms, functioning, and well-being at the same level as the partially working group. However, their therapists reported that they functioned better and they themselves considered work demands somewhat less stressful. CONCLUSIONS THE RESULTS INDICATE THAT BOTH SYMPTOMS AND FUNCTIONAL CAPACITY, IN ADDITION TO WORK ENVIRONMENT, ARE PERCEIVED AS MORE FAVORABLE AMONG FULLY WORKING PATIENTS, COMPARED WITH THOSE COMPLETELY ON SICK LEAVE HOWEVER, BECAUSE OF THE CROSS-SECTIONAL DESIGN, WE NEED MORE STUDIES WITH PROSPECTIVE DESIGN TO EXAMINE WHETHER THESE RELATIONSHIPS ARE CAUSAL, AND TO EXAMINE WHEN SICKNESS PRESENCE IS BENEFICIAL FOR PATIENTS.