Clinical guideline for the diagnosis and management of work-related mental health conditions in general practice: Development and draft recommendations

Problem

Work-related mental health conditions are increasing globally, with significant economical and social costs to the individual and the community. Similarly to the UK, in Australia general practitioners (GPs) are the first point of care for most injured workers. However GPs, patients and other key stakeholders such as employers and compensation agents agree that management of work-related mental health injuries by GPs is suboptimal. GPs themselves request advice and support to diagnose and manage work-related mental health conditions. Yet to date, there are no clinical guidelines on this subject. The aim of this study is to develop clinical guidelines to help GPs improve their management of patients with work-related MHCs.

Approach

Clinical guidelines were developed according to the standards and procedures outlined by the National Health and Medical Research Council (NHMRC) in Australia. An interdisciplinary Guideline Development Group oversaw the development of the guidelines. Key questions for the guideline were determined by first engaging with end-users to identify the clinical challenges that GPs faced in practice and subsequently converting these into key clinical questions. A systematic review was conducted to answer each key clinical question and the results of each review were used to inform recommendations. The Guideline Development Group used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the quality of the evidence and appropriateness for the GP context, and to assign a strength to each recommendation. Where we found no evidence to address a key clinical question, we drew on expert opinions to form a consensus statement. To facilitate implementation, the guideline will receive approval from the NHMRC and endorsement from the Royal Australian College of General Practitioners (RACGP). An implementation and dissemination plan is also being developed concurrently.

Findings

A draft clinical guideline has been developed to provide evidence-based advice to GPs regarding diagnosing and managing work-related mental health conditions. The guideline considers ten topics: 1) diagnosing a mental health condition; 2) determining the work-relatedness of a condition; 3) ensuring that patients understand and acknowledge the diagnosis; 4) identification of co-morbidities; 5) management; 6) delayed recovery; 7) management options to combat delayed recovery; 8) strategies for managing co-morbidities; 9) communication with a workplace and 10) determining readiness to work.

Consequences

The draft guideline and implementation plan will be submitted for NHMRC approval and RACGP endorsement in 2018 and will be published early in 2019. The guideline is intended for use by GPs to optimise their management of patients with work-related mental health conditions. These guidelines may also be utilised by compensable schemes and employers to engage with GPs and other health practitioners to facilitate patient recovery and return to work.