WITHDRAWN - What is the feasibility of recruiting to an occupational health intervention trial and how does it compare to recruitment to other primary care trials?

Problem

Government statistics report that around 131 million work days were lost due to sickness absences in the UK in 2013 (ONS 2014). Absences of greater than 4 weeks affect around 1% of employees and comprise only 6% of total absences, but contribute to nearly half the total days lost. One third of employers rely solely on the NHS to support their employees through sickness absences.

Despite the clear case for robust intervention, evidence is lacking for how to best support and manage patients return to work after long term absence.

Approach

We developed a pilot trial of a collaborative case management intervention for people who are on long-term sickness absence (between 4 weeks and 12 months). It is a split site pilot study with part of the recruitment being done through primary care to target patients who do not have access to employer occupational health support services.

We are using the methods that have underpinned many similar trials: recruitment invitations going out to those on current lists identified as on ‘long-term sick’, with patients opting into the study (followed by eligibility assessment). Although these methods are well used in primary care research, the occupational context is different, so a key aim was to assess identification procedures and response rates to recruitment invitations.

Findings

As of February 2016, we had recruited 8 GP practices to identify patients who had been given Fit Notes for 4 weeks or more. From this total population of around 44,000 patients, just 420 potentially eligible patients were identified. After screening by the GP invitation packs were sent out to 273 patients from which we received responses from just 14. The identification of candidates and response rates are far lower than expected – currently running at 1.1%.

We have identified a number of issues around identification and recruitment of this population from general practice databases.

Comparing the response rates we have had with those of similar occupational health trials both in the UK and internationally shows that this appears to be a consistent problem.

Consequences

For many patients the only support available to them when they have extended periods off work is through their primary care team and there is little direct occupational health support available to them. However they appear to be reluctant to engage in research in this area.

The issue of long-term sickness absence remains important, and there is still a need to conduct large trials to assess treatment options in this setting. Overcoming these issues to recruitment will have an important impact on further trials.