Table 2

Integrated care and workplace intervention protocol

Weeks after surgery

Integrated care protocol

Carried out by the clinical occupational physician

Workplace intervention protocol

Carried out by the Occupational Therapist (OT)


10-11

First consultation:

a. History taking and physical examination to identify:

• adequacy of illness behaviour

• presence of psychosocial problems

• inadequate treatment

• limitations at work influencing RTW (e.g. physical heavy work, organizational obstacles).

b. Contact patients' other care providers (if relevant).

c. Diagnosis of the medical situation or problem(s)

d. Propose a treatment and rehabilitation plan (with a RTW prognosis).

e. Discuss the treatment and rehabilitation plan with the patient and her occupational physician. If both agree

Contact OT to start the workplace intervention protocol (if relevant)


First consultation:

12-13

Call in the assistance of patients' employer and relevant care provider(s)

Discuss the advisory plan (developed by the OT) with the OT

a. Observation, inventory and ranking of patient's tasks and obstacles for RTW at the patients' workplace.

b. Inventory and ranking patients' tasks and obstacles for RTW by the patients' employer.

c. Patient, patients' employer and the OT brainstorm and discuss as many potential solutions as possible, for the problems identified in step a en b.

d. Solutions are sorted and prioritized based on implementation time, costs and contribution to the problem(s).

The OT reports (in consultation with the clinical occupational physician) an advisory plan specifying what has to be done, how, when and by whom. This report is sent to the patient, the patient's employer, OP and the clinical occupational physician.


14-15

Optional worksite visit to give additional instructions or training to the patient on working in the modified setting.


16-17

Second consultation:

a. Evaluate the diagnosis, effect of the treatment and progress

b. If necessary, adjust the date of RTW

Evaluation between the patient, patients' employer and the OT (by telephone) with regard to the effects of the workplace adaptations. Further improvements are sought for when solutions have prove not to be totally effective.


19-20

Final report is sent to the patient, the patient's employer, OP and the clinical occupational physician.


22-23

Third and final consultation:

a. Evaluate the diagnosis, effect of the treatment and progress

b. If necessary, adjust the date of RTW

c. Hand the employee over to her own OP


Abbreviations: RTW = Return to Work, OT = Occupational Therapist; OP = Occupational Physician

Vonk Noordegraaf et al. BMC Health Services Research 2012 12:29   doi:10.1186/1472-6963-12-29

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