Bert Cornelius

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BackgroundScreening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.MethodsAll scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach’s α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.ResultsCronbach’s alpha’s were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC’s for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).ConclusionsThe K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

Training Belastbaarheidgericht Beoordelingsgesprek (BGB): Evaluatie van de training en de methode

SamenvattingHet Belastbaarheidgericht Beoordelingsgesprek (BGB) is een semigestructureerde gespreksmethode om de belastbaarheid te beoordelen van cliënten die een arbeidsongeschiktheidsuitkering aanvragen. Doel van deze studie is te onderzoeken hoe verzekeringsartsen de BGB-methode en een training in deze methode evalueren. Methode: 55 verzekeringsartsen volgden een driedaagse BGB-training. Voor, direct na en drie maanden na de training vulden de verzekeringsartsen vragenlijsten in met vragen over hun waardering voor en de bruikbaarheid van de BGB gespreksmethode en de training. Resultaten: De BGB-training wordt geëvalueerd met een 8,3 op een 10-puntsschaal. 90% van de artsen vindt de BGB een acceptabele gespreksmethode en geeft aan onderdelen van de methode te gebruiken in de praktijk. Meest gewaardeerde onderdelen zijn het structureren en het doorvragen naar concrete voorbeelden van ervaren belemmeringen. Ziektewetartsen geven vaker dan WIA-artsen aan alleen onderdelen van de methode te gebruiken omdat ze de gehele methode vaak te uitgebreid vinden.SummaryTraining for the Disability Assessment Structured Interview (DASI):An evaluation of the training and the method Disability assessments are an important task of the insurance physician in the process of approving disability benefits. In practice an insurance physician bases his opinion mainly on the assessment interview with the client.The Disability Assessment Structured Interview (DASI) is a semi-structured interview protocol for insurance physicians to be used in assessing the functional limitations of disability benefit claimants. It has five main topics: work, illness, experienced limitation, participation and client’s vision, largely based on the ICF model. The method has three important characteristics: the topics are strictly separated, there is a request for specific examples of limitations and participation efforts, and the interview has to be non-normative.The aim of this study is to assess how insurance physicians evaluate the DASI method and the preceding training.Method: 55 insurance physicians applied for a three-day DASI training including theory, instruction and practice involving role-play. The physicians were then asked to use the method with regular clients for two weeks, followed by an evaluation day.Before, directly after and three months after training the insurance physicians filled out questionnaires concerning their motivation and expectations (T0), and their opinion of the DASI interview method and training and the usefulness of the method (T1, T2). Results: The DASI training was evaluated with an 8.3 on a ten-point scale. Most physicians (90%) found the DASI to be an acceptable interview method and indicated that they would use parts of the method in daily practice. The parts most appreciated were the structure of the method and the exploration of concrete examples of experienced limitations. Physicians assessing short term disability indicated more often that they used only parts of the DASI than physicians assessing long term disability. They considered the full DASI interview to be too elaborate for assessing short term disability.It is recommended to adapt the method for specific target groups.

Dilemma voor de verzekeringsarts: een klein vlekje met grote gevolgen?

SamenvattingIn hun rol als poortwachter van sociale voorzieningen dienen verzekeringsartsen in beoordelingen van cliënten met een beperkte levensverwachting door kanker het maatschappelijke belang af te wegen tegen het persoonlijke belang van de cliënt. Wanneer laten zij de keuze om nog aan het arbeidsproces deel te nemen over aan de cliënt? Wanneer gaan zij aan het persoonlijke belang voorbij en laten ze het maatschappelijke belang prevaleren?In de toekomst wordt deze afweging steeds vaker gevraagd van verzekeringsartsen omdat kanker door betere behandelmethoden steeds meer een chronische aandoening wordt. Het belang van het gebruik van evidence based medicine bij claimbeoordelingen neemt toe.Dit artikel van de commissie Ethiek van de NVVG beoogt inzichtelijk te maken met welke argumenten de verzekeringsarts tot de beslissing kan komen om een verzekerde met een beperkte levensverwachting door kanker wel of niet belastbaar voor arbeid te achten en om verzekeringsartsen handreikingen te bieden waarmee zijzelf tot een afweging kunnen komen.SummaryIn their role as gatekeeper of social services, insurance physicians while assessing clients with a limited life expectancy by cancer have to weigh the public interest against the personal interest of the client. Since cancer is becoming more of a chronic condition through better treatment methods, this weighing process will be increasingly important in the future. In addition, the use of evidence-based medicine in claim assessments is becoming more and more important.This article from the Ethics Committee of the Netherlands Society of Insurance Medicine NVVG aims to support insurance physicians in their assessment of persons with a limited life expectancy by cancer and to help them answer the question whether clients are able to work or not.

Effects of a training in the Disability Assessment Structured Interview on the interviews of Dutch insurance physicians

Abstract Purpose: The Disability Assessment Structured Interview (DASI) is a semi-structured interview for assessing functional limitations of claimants in a work disability evaluation. The aim of this study is to evaluate the effect of a 3-day DASI training course on the quality of assessment interviews of insurance physicians (IPs). Methods: In a pretest–posttest study, 55 IPs employed at the Dutch National Institute for Employee Benefits Schemes completed a 3-day DASI training. Before (T0), directly after the training (T1) and after 3 months follow-up (T2), these IPs filled out questionnaires that measured knowledge, skills, attitude and self-efficacy. Furthermore, in 10 disability assessment cases interview duration, IP’s satisfaction, amount of acquired information and confidence of judgement were measured. Finally, the amount of information reported was measured in three randomly selected disability assessment reports of each IP. Results: IP’s knowledge, skills and self-efficacy improved significantly after the training. The attitude of the IPs changed towards a more open attitude and structuring of the interview. Satisfaction about the interview, amount of acquired information and confidence of their judgement all increased. Conclusions: The DASI training improved the quality of assessment interviews of IPs. A semi-structured interview, like the DASI, can help physicians to pay more attention to activity limitations and participation in addition to medical information. Implications for Rehabilitation Experienced IPs are able to change their disability assessment interview routine after training. In determining work ability, IPs should pay more attention to claimant’s activity limitations and participation in addition to medical information. A semi-structured interview as the DASI can help IPs to pay more attention to claimant’s functioning. A 3-day DASI training for IPs can increase their confidence in their judgement and provides significantly more information in their assessment reports.

The assessment by insurance physicians of functional limitations related to mental disorders among disability benefit claimants

SamenvattingWe investigated under- and over-recognition of functional limitations related to mental disorders by insurance physicians (IPs) in disability benefit claimants with and without mental disorders. The sample consisted of 247 persons claiming disability after two years of sickness absence. All respondents were interviewed using the Composite International Diagnostic Interview (CIDI) generating mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) present in the past thirty days. Functional limitations related to mental disorders as reported by IPs were extracted from registry. Under-recognition of functional limitations related to mental disorders for any mental disorder was found in 15.7%, for mood disorders in 7.1% and for anxiety disorders in 16.4%. Over-recognition of functional limitations related to mental disorders for any mental disorder was found in 41.2%, for mood disorders in 48.4% and for anxiety disorders in 44.8%. Under-recognition of functional limitations related to mental disorders is limited. Apparently IPs primarily focus on functional limitations and impairments, and not on the causal illness. Over-recognition of functional limitations related to mental disorders is more pronounced.

Supporting work participation of people with a chronic disease

SamenvattingNaarmate de arbeidsongeschiktheid van mensen met een chronische ziekte voortduurt, lijken andere niet-medische factoren een belangrijkere rol te gaan spelen bij werkbehoud en werkhervatting. Dan zullen mogelijk andere interventies moeten worden ingezet.

How to handle dilemmas in insurance medicine

SamenvattingIn their daily practice insurance physicians (IPs) are confronted with complex decisions in which they have to make a trade-off between the individual’s interest and the interest of society. This can lead to ethical dilemmas. ‘Moral Consideration’ is a procedure that can be used to handle dilemmas in insurance medicine. In this paper, we describe seven examples of ethical dilemmas. It is important that IPs are aware that they face dilemmas in their work every day and need to discuss these dilemmas with colleagues and share the results of these discussions.

Answering questions at a congress: do’s and don’ts

SamenvattingDuring your specialisation in insurance medicine you did some nice research with interesting results and the article you wrote has been accepted for publication in a scientific journal. Great! Filled with pride and joy you pluck up courage and submit the abstract to present at an international scientific congress.

Participatiegedrag van cliënten met een arbeidsongeschiktheidsuitkering: Vanuit het perspectief van verzekeringsartsen

SamenvattingDoel van dit onderzoek is het inventariseren van standpunten en meningen van verzekeringsartsen over participatiegedrag van cliënten met een arbeidsongeschiktheidsuitkering en van factoren die zij associëren met inadequaat participatiegedrag. Daartoe hebben wij tijdens tien bijeenkomsten Onderlinge Toetsing aan in totaal 78 verzekeringsartsen die werken bij het UWV open vragen voorgelegd over (in) adequaat participatiegedrag. Een aantal thema’s die om nader onderzoek en verheldering vroegen, legden we in een latere discussiemeeting voor aan acht verzekeringsartsen. Uit de antwoorden van de verzekeringsartsen kwam een brede biopsychosociale, genuanceerde benadering van participatiegedrag naar voren binnen het raamwerk van de ICF. We concludeerden dat verzekeringsartsen participatiegedrag benaderen vanuit een breed biopsychosociaal perspectief. Daarmee samenhangend kunnen verzekeringsartsen participatiegedrag niet beoordelen vanuit algemeen toepasbare criteria. Verzekeringsartsen houden bij beoordeling van participatiegedrag rekening met de specifieke kenmerken en omstandigheden van de individuele cliënt. Het onderzoek is een eerste systematische inventarisatie van factoren die een rol kunnen spelen bij participatiegedrag, zoals dat beoordeeld wordt in de verzekeringsgeneeskundige praktijk. Er is aanvullend onderzoek nodig om dit complexe begrip beter te kunnen beoordelen en te hanteren in de praktijk.

Exploring participatory behaviour of disability benefit claimants from an insurance physician’s perspective

Abstract Purpose: In the Dutch social security system, insurance physicians (IPs) assess participatory behaviour as part of the overall disability claim assessment. This study aims to explore the views and opinions of IPs regarding participatory behaviour as well as factors related to inadequate participatory behaviour, and to incorporate these factors in the International Classification of Functioning, Disability and Health (ICF) biopsychosocial framework. Method: This qualitative study collected data by means of open-ended questions in 10 meetings of local peer review groups (PRGs) which included a total of 78 IPs of the Dutch Social Security Institute. In addition, a concluding discussion meeting with 8 IPs was organized. Results: After qualitative data analyses, four major themes emerged: (1) participation as an outcome, (2) efforts of disability benefit claimants in the process of participatory behaviour, (3) beliefs of disability benefit claimants concerning participation, and (4) recovery behaviour. Identified factors of inadequate participatory behaviour covered all ICF domains, including activities, environmental, and personal factors, next to factors related to health condition and body functions or structures. Outcomes of the discussion meeting indicated the impossibility of formulating general applicable criteria for quantifying and qualifying participatory behaviour. Conclusions: Views of IPs on disability benefit claimants’ (in)adequate participatory behaviour reflect a broad biopsychosocial perspective. IPs adopt a nuanced tailor-made approach during assessment of individual disability benefit claimants’ participatory behaviour and related expected activities aimed at recovery of health and RTW. Implications for Rehabilitation Within a biopsychosocial perspective, it is not possible to formulate general criteria for the assessment of participatory behaviour for each unique case. Individual disability benefit claimant characteristics and circumstances are taken into account. To optimize the return-to-work (RTW) process, insurance physicians (IPs) assess participatory behaviour according to the International Classification of Functioning, Disability and Health, including medical, personal, and environmental factors. Some aspects within the concept of participatory behaviour extend beyond the boundaries of the domain where IPs operate because opinions in society on personal and societal responsibility influence participatory behaviour.