Training GPs to improve their management of work-related problems: results of a cluster randomized controlled trial.

Background: Paying attention to their patients' work and recognizing work-related problems is challenging for many general practitioners (GPs).
Objectives: To assess the effect of training designed to improve the care for patients with work-related problems in general practice.
Methods: A cluster randomized controlled trial among 32 Dutch GPs. GPs in the intervention group received five-hour training. GPs in the control group were not trained. Included patients (age 18-63, working ≥12 h per week) completed baseline questionnaires and follow-up questionnaires planned after one year. Primary outcome at patient level was patients' expectations about their ability to work, measured using the return-to-work self-efficacy scale (RTW-SE). Primary outcomes on GP level were their use of ICPC-code Z05 ('work-related problem') per 1000 working-age patients and percentage of the electronic medical files of working-age patients in which information about occupation had been recorded.
Results: A total of 640 patients completed the baseline questionnaire and 281 the follow-up questionnaire. We found no statistically significant differences in patients' RTW-SE scores: intervention 4.6 (95%CI: 4.2-5.0); control 4.5 (95%CI: 4.1-4.9). Twenty-nine GPs provided data about the GP-level outcomes, which showed no statistically significant differences: use of ICPC code Z05 11.6 (95%CI: 4.7-18.6) versus 6.0 (95%CI: -1.2 to 13.2) per 1000 working-age patients; recording of occupation 28.8% (95%CI: 25.8-31.7) versus 28.6% (95%CI: 25.6-31.6).
Conclusion: Training GPs did not improve patients' work-related self-efficacy or GPs' registration of work-related problems and occupation.