Sofie Vandenbroeck

Patient-reported outcomes (PRO's) in glaucoma: a systematic review

The aim of this review was to summarize literature in view of patient-reported outcome (PRO) instruments for glaucoma and provide guidance on how outcomes are best assessed based on evidence about their content and validity. A systematic literature review was performed on papers describing the developmental process and/or psychometric properties of glaucoma or vision-specific PRO-instruments. Each of them was assessed on their adherence to a framework of quality criteria. Fifty-three articles were identified addressing 27 PRO-instruments. In all, 18 PROs were developed for glaucoma and 9 for diverse ophthalmologic conditions. Seven instruments addressed functional status, 11 instruments quality of life and 9 instruments disease and treatment-related factors. Most of the instruments demonstrated only partially adherence to predefined quality standards. The tools for assessing functional status were of poor quality, while the Glaucoma Quality of Life Questionnaire and the Vision Quality of Life Index were well-developed QoL measures, yet only validated using classical techniques. The Rasch-scaled QoL-tools, IVI and VCM1 need to improve their item-content for glaucoma patients. The questionnaires to measure adherence should improve their validity and the Treatment Satisfaction Survey for Intra Ocular Pressure pops out as the highest quality tool for measuring topical treatment side effects. This review revealed that most PRO-instruments demonstrated poor developmental quality, more specifically a lack of conceptual framework and item generation strategies not involving the patients’ perspective. Psychometric characteristics were mostly tested using classical validation techniques.

Increased Risk of Burnout for Physicians and Nurses Involved in a Patient Safety Incident.

Background:Human errors occur everywhere, including in health care. Not only the patient, but also the involved health professional is affected (ie, the “second victim”). Objectives:To investigate the prevalence of health care professionals being personally involved in a patient safety incident (PSI), as well as the relationship of involvement and degree of harm with problematic medication use, excessive alcohol consumption, risk of burnout, work-home interference (WHI), and turnover intentions. Research Design:Multilevel path analyses were conducted to analyze cross-sectional survey data from 37 Belgian hospitals. Subjects:A total of 5788 nurses (79.4%) and physicians (20.6%) in 26 acute and 11 psychiatric hospitals were included. Measures:“Involvement in a patient safety incident during the prior 6 months,” “degree of harm,” and 5 outcomes were measured using self-report scales. Results:Nine percent of the total sample had been involved in a PSI during the prior 6 months. Involvement in a PSI was related to a greater risk of burnout (&bgr;=0.40, OR=2.07), to problematic medication use (&bgr;=0.33, OR=1.84), to greater WHI (&bgr;=0.24), and to more turnover intentions (&bgr;=0.22). Harm to the patient was a predictor of problematic medication use (&bgr;=0.14, OR=1.56), risk of burnout (&bgr;=0.16, OR=1.62), and WHI (&bgr;=0.19). Conclusions:Second victims experience significant negative outcomes in the aftermath of a PSI. An appropriate organizational response should be provided to mitigate the negative effects.

Burnout in Belgian physicians and nurses

Background Burnout in healthcare is a worldwide problem. However, most studies focus narrowly on work-related factors and outcomes in one health profession or speciality. Aims To investigate the prevalence of burnout and its association with job demands, job resources, individual well-being, work-related attitudes and behaviour in physicians and nurses across different specialties. Methods Multi-centre cross-sectional study of physicians and nurses working in Belgian hospitals. An electronic questionnaire was used to assess job demands (e.g. workload), job resources (e.g. autonomy) and indicators of well-being, work-related attitudes and behaviours. Structural equation modelling was used to examine interrelationships between explanatory variables and outcomes. Results 1169 physicians and 4531 nurses participated; response rate 26%. High scores (>75th percentile in reference group of Dutch health care workers) were seen in 6% of the sample on three burnout dimensions (i.e. emotional exhaustion, depersonalization and personal competence) and in 13% for at least two dimensions. In contrast to the other dimensions, emotional exhaustion strongly related to almost all variables examined in the model. Positive associations were seen with workload, role conflicts, emotional burden and work-home interference and negative associations with learning and development opportunities and co-worker support. Emotional exhaustion correlated negatively with well-being, turnover intention, being prepared and able to work until retirement age, medication use, absenteeism and presenteeism. Conclusions Work-related factors were critical correlates of emotional exhaustion, which strongly related to poor health and turnover intention. Randomized controlled trials are suggested to underpin the effectiveness of interventions tackling job stressors and promoting job resources.

1498 Basic typology of sentinel and alert approaches to identify new and emerging work-related diseases

Objective Changes in working conditions give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential for their early recognition and prevention and requires a comprehensive approach, using several complementary methods. The aim of this review is to provide an overview and basic typology of different approaches to detect new/emerging WRDs. Methods We conducted an extensive scientific literature search combining terms for the following three concepts: surveillance/reporting systems; occupational/work–related diseases; and new or emerging risks. In addition, a grey literature search was performed of both grey literature databases and relevant EU and research institute websites for additional resources. Results We identified a total of 75 surveillance systems from 26 different countries. We set up a basic typology of these systems dividing them into four main groups. Compensation-based systems (n=22) were designed to gather data for compensation purposes and are insurance-driven. Non-compensation-related systems (n=34) were created with the aim of improving the collection and analysis of data to measure trends in occupational and work-related diseases. Sentinel systems (n=12) were specifically designed to provide a warning signal that will initiate health interventions and preventive actions. Finally, public health surveillance systems (n=7) aim to monitor the health of the general population, but can also be used for work-related surveillance. These four main types further differed in terms of disease coverage, means of data collection, evaluation of work-relatedness, follow-up of new/emerging risks, link with prevention etc. Conclusion Sentinel systems seem to have the most suitable approach to detect and alert to new/emerging WRDs. Nevertheless, systems identified in the other three groups can also contribute to identifying new/emerging WRDs, despite being primarily designed for other purposes.

790 Predicting long-term sickness absence and supporting return-to work processes using questionnaires

Introduction Promoting good health and attendance, instead of penalising absence, has become a growing policy issue, since long-term sickness absence is increasing in 27 European member states and Norway. As most employees will return to work spontaneously, resources for return to work projects should be dedicated to the high-risk group for long-term sickness absence. Methods In this project, a questionnaire was developed to predict the risk of long-term sickness absence. By combining a literature review of the predictive factors for long-term sickness absence, with a review of existing questionnaires that question long-term sickness absence, a new questionnaire was developed. A study has been set up including 10 000 participants, to assess the predictive value of the questionnaire and the model to predict the risk of long-term sickness absence. Results The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is the patient’s expectancy regarding their return to work. As the other predictive value of the other factors was ambiguously, the pilot study will explore the value of the complete model and each separate parameter. The developed questionnaire is not specific for a certain illness, nor for use in a specific country. Discussion The questionnaire developed in this research aims to support physicians to assess the risk of long-term sickness absence, wherefore an earlier start of return-to work support becomes possible. We aim to guide more employees successfully and sustainably back to work.

Screening for the risk on long-term sickness absence

Background: Long-term sickness absence is a growing concern in Belgium and other European countries. Since 2017, Belgian physicians of the sickness funding organisations are required to assess the re-integration possibilities within the first two months of sickness absence. Given the shortage of physicians in the assessment of work disability and the growing number of people in sickness absence, there is a need for a triage tool, allowing to assign return-to work support to patients having a high-risk profile not to resume work. Methods/design: The current study comprises a comprehensive validation process of a screening tool that supports Belgian physicians in guiding people back to work. The study consists of a theoretical construct validation (face validity and content validity), and an empirical construct validation (concurrence validity, factorial validity, predictive validity, hypothesis testing validity and known- group validity). Expected impact of the study for Public Health: The screening instrument assessing the risk for long-term sickness absence is a tool developed to support physicians who work for sickness funds and for occupational health and safety organisations. Both professionals play an important role in the return to work process and the prevention of long-term sickness absence. The screening tool aims at making a distinction between people who will resume their work independently and people who will need support to do so. Generation of this prediction model will help physicians to focus effort and resources in the high-risk group. Results may also help understand the relationship between the biopsychosocial model and long-term sick-leave. Significance for public health In this research, we tested a generic instrument to screen for long-term sickness absence, regardless the cause of the sickness absence or the political context. Both biomedical factors and psychosocial factors (such as the patients’ own prediction) are questioned in the prediction model, which is thus adapted to the modern view on sick leave. A screening method to detect high risk of long-term sickness absence among the large group of sick employees might help to use resources (e.g. money, services) in a more efficient way. Physicians will be able to focus on patients with a high risk on long-term sick leave, and the return to work process of employees at high risk can start much earlier. The instrument will, next to the physicians’ prognosis, offer support in prioritizing patients’ files. Hence, a lot of patients will resume their work spontaneously. Patients who need support will experience shorter follow-up periods, and better quality of care. In addition, the relationship between predicting factors of the biopsychosocial model and long-term sickness absence will be examined.

Is langdurig ziekteverzuim voorspelbaar en meetbaar

SamenvattingLangdurig verzuim blijft toenemen en zieke werknemers worden onvoldoende ondersteund bij hun terugkeer! In dit artikel geven we een overzicht van de voorspellende factoren voor een succesvolle terugkeer naar het werk en een overzicht van vragenlijsten die in dit verband kunnen gebruikt worden.

0175 Different approaches for early recognition and prevention of new and emerging work-related diseases

Rapid changes in working conditions constantly give rise to new occupational health risks and work-related diseases (WRDs). Monitoring these new WRDs is essential from the aspects of early recognition and prevention. In addition, it requires a comprehensive approach, using several complementary methods. One of these methods are early warning systems designed to collect information on health effects in order to trigger interventions and prevention. These systems differ in characteristics, their ability to capture new WRDs and their link with prevention. Therefore, the aim of this study is to identify sentinel and alert systems for detecting new and emerging WRDs, describe their main characteristics, and set up a basic typology. In the first phase, we conducted an extensive scientific and grey literature review and we identified 75 surveillance systems covering 26 different countries. We set up a basic typology of these systems dividing them into four main groups: compensation-based systems (21), non-compensation related comprehensive systems (38), sentinel systems (12) and public health surveillance systems aimed at workers and non-workers (7). These systems further differed in type of WRDs, coverage, data collection, evaluation of work-relatedness; follow up of new/emerging risks, link with prevention etc. In the second phase, we chose a representative selection of 12 good practise examples to be described in-depth. Through a desk research and interviews with stakeholders, we gained additional insight into drivers and obstacles regarding these systems and usage of collected data for identification of WRDs, prevention and policy recommendations.

0181 Methodologies to identify work-related diseases: in-depth description of selected of sentinel or alert systems

Objectives Drawing on a literature review on sentinel and alert systems for identifying new/emerging work-related diseases (WRDs) a basic typology of systems was developed. These systems differ in characteristics, ability to capture new WRDs and link with prevention. The objectives of the subsequent study of a subset of systems were to describe in-depth aims, drivers and obstacles of the systems and use of their data in practice, for prevention and detecting new/emerging WRDs. Methods Twelve systems were chosen reflecting the different types (linked to compensation or not, aimed at all WRDs or a subset of diseases, sentinel systems, workers only or general public). Six systems were described based on desk research and six other systems were studied through interviews with different actors to gather information on the operation of the systems and the use of the gathered data for prevention. Results Several important themes emerged from the comparative tables, related to the design and performance of the system: visibility, reporting methods, exposure assessment, data quality, linkage to other institutions, and related to data use for prevention, alert on hazardous situations, awareness on new/emerging diseases. Conclusions Each system has its strengths and limitations, closely related to its purpose and the country that developed it. Sentinel systems seem to be best equipped for prevention and alert on new/emerging diseases. Enhancing reporting needs to balance required information and perceived reward for reporters. Embedding of systems in governmental or public health organisations is important in terms of financing, expertise and dissemination of results.

0120 Predicting long-term sickness absence and supporting return-to work processes, a quantitative research

Long-term sickness absence is increasing in 27 European member states and Norway. Promoting good health and attendance, instead of penalising absence, has become a growing policy issue (Edwards & Greasley, 2010). As most employees will return to work spontaneously, resources for return to work projects should be focused on the high-risk group for long-term sickness absence. In this project a questionnaire was developed to predict the risk of long-term sickness absence. The development of the questionnaire started with a literature review of the predictive factors for long-term sickness absence, and with a review of existing questionnaires that question long-term sickness absence. The questionnaire will be validated in a pilot study of 10 000 participants. These data will be used to calculate its predictive value and to build a model to predict the risk of long-term sickness absence. The literature study revealed 16 predictors for long-term sickness absence. The most predictive factor is, according to existing research, the patient‘s expectancy regarding their return to work. As the other factors are not unambiguously strong predictors, the pilot study will explore the predictive value of the complete model and each separate parameter. A new questionnaire was developed based on both reviews and the 16 predictors they revealed. The questionnaire is not specific for a certain illness, nor for use in a specific country. The questionnaire developed in this research will support physicians to assess the risk of long-term sickness absence, and to guide more employees successfully and sustainably back to work.