■员工疾病缺勤和出勤(身体不适时参加工作)会给NHS带来高昂的成本,与患者不良结局相关,并因COVID-19大流行而加剧。主要原因是精神和肌肉骨骼疾病,心血管危险因素常见。
■进行一项可行性研究,以告知设计一项确定的随机对照试验,以了解健康筛查诊所在减少国家卫生服务人员中的旷工和出勤率方面的有效性和成本效益。
■与常规护理相比,工作人员健康筛查诊所的个人随机对照试点试验,包括定性过程评估。
■来自两个城市和一个农村信托的四个英国国家卫生服务医院。
■以前没有在伯明翰伊丽莎白女王医院参加过试点健康检查诊所的医院雇员。
■护士领导的员工健康筛查诊所,评估肌肉骨骼健康(STarT肌肉骨骼;STarTBack),心理健康(患者健康问卷-9;广泛性焦虑症问卷-7)和心血管健康(NHS健康检查,如果年龄≥40岁,生活方式检查,如果<40岁)。根据英国指南,为屏幕阳性提供建议和/或转介服务。
■三个共同结果是招募,转介和出席转介服务。当一起考虑时,这些形成了停/走标准。如果这些值中的任何一个落入“琥珀色”区域,那么审判将需要修改才能进行全面审判。如果所有的都是红色的,那么审判将被认为是不可行的。为最终随机对照试验的设计而收集的次要结果包括:普遍性,筛选结果,需要/参加的个人转介,健康行为,工艺的可接受性/可行性,污染和成本的指示。与最终试验相关的结果包括自我报告和员工旷工记录以及原因。过程评估包括与参与者的访谈,干预交付人员和服务提供商。提出了描述性统计数据,并对定性数据进行了框架分析。由于COVID-19大流行,结果仅在6个月内被捕获.
■三百十四个参与者同意(236随机),大多数在4个月内。邀请的314/3788(8.3%)的招聘率低于预期(符合此标准的红色),但是筛查发现,随机分组的57/118(48.3%)符合转诊至全科医生(81%),心理健康(18%)和/或物理治疗服务(30%)(绿色)。早日结束审判排除了确定出庭作证的可能性,但31.6%的合资格人士报告打算出席(琥珀色)。在计划进行的80次定性访谈中,有51次(63.75%)进行了定性访谈。过程评估的定量和定性数据表明,电子数据库驱动的筛查干预和数据收集是有效的,促进良好的保真度,虽然有时需要更多的个性化。招募和交付全面审判将受益于更长的开发期,以更好地了解当地情况,制定有效的战略,与服务不足的群体接触,提供更长的培训,并与转介服务更好地整合。由于COVID-19对工作人员调动的影响,试点的交付受到限制,COVID研究优先考虑和减少社区和内部转诊服务的可用性。虽然招聘迅速,它没有完全代表少数族裔群体,并且由于资金限制而导致的随访中断,无法对推荐服务的出勤率和次要结局进行全面评估.
■这个国家卫生服务人员的健康筛查诊所既有临床需求(48%的筛查合格转诊证明),也有感知的益处(来自定性访谈的数据)。三个停/走标准是红色的,绿色和琥珀色;因此,审判监督委员会建议进行全面审判,但要进行修改,以适应当地情况,并采用更好地与服务不足的社区接触的程序。
■本试验注册为ISRCTN10237475。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:17/42/42)资助,并在《健康与社会护理提供研究》中全文发表。12号23.有关更多奖项信息,请参阅NIHR资助和奖励网站。
疾病缺勤和出勤(生病时出勤,工作表现不佳)是NHS中的主要问题,并与较差的患者医疗保健有关。NHS员工缺勤和出勤的最常见原因是肌肉不适和精神疾病。不良的生活方式和与心脏病相关的疾病也是重要因素。员工健康检查可能会改善NHS员工的健康状况,但是没有研究包括筛查测试来解决员工健康状况不佳的最常见原因。这项初步研究测试了是否有可能对NHS员工健康筛查诊所进行随机对照试验,有些人得到筛查检查,而另一些人没有(随机选择,就像掷硬币一样)。我们使用电子数据库来捕获所有数据。参与者在家中或工作中完成了初始问卷,然后参加了面对面的筛查诊所,使用公认的筛查问卷和测试来检测肌肉问题,精神或心脏健康。我们考虑了NHS员工和医疗机构如何希望筛查诊所和试验运行,如何最好地接触各种各样的NHS工作人员,可能需要邀请多少员工,以及他们的医疗保健需求。这项研究在COVID-19大流行期间在英国的四家NHS医院进行。136名NHS工作人员参加了会议,但由于大流行而导致的早期试验结束意味着一些结果无法获得.对于主要的可行性结果,尽管约8%的招聘率低于预期,一半接受筛查的工作人员需要转诊以接受进一步的医疗保健,三分之一的工作人员报告打算参加。工作人员认为该诊所解决了重要的健康需求。审判监督委员会建议进行全面审判,但要修改以解决程序评估的结果,包括鼓励更广泛的NHS员工参加的方法。
UNASSIGNED: Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the
NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common.
UNASSIGNED: To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff.
UNASSIGNED: Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation.
UNASSIGNED: Four United Kingdom National Health Service hospitals from two urban and one rural Trust.
UNASSIGNED: Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham.
UNASSIGNED: Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines.
UNASSIGNED: The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the \'amber\' zone, then the trial would require modifications to proceed to full trial. If all were \'red\', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only.
UNASSIGNED: Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes.
UNASSIGNED: There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities.
UNASSIGNED: This trial is registered as ISRCTN10237475.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.
Sickness absenteeism and presenteeism (attendance at work while ill, with poor work performance) are major problems in the NHS and associated with worse patient health care. The most common causes of
NHS staff sickness absenteeism and presenteeism are muscular complaints and mental ill health. Poor lifestyle and illnesses associated with heart disease are also important factors. Staff health checks might improve the health of NHS staff, but no studies have included screening tests to address the most common causes of poor staff health. This pilot study tested whether it would be possible to deliver a randomised controlled trial of an NHS staff health screening clinic, where some people get the screening check and others do not (chosen at random, like flipping a coin). We used an electronic database to capture all data. Participants completed initial questionnaires either at home or at work, then attended a face-to-face screening clinic using recognised screening questionnaires and tests to detect problems with muscular, mental or heart health. We considered how
NHS staff and healthcare organisations would want the screening clinic and trial to run, how a diverse range of NHS staff could best be approached, how many staff might need to be invited and what their healthcare needs would be. The study ran in four UK
NHS hospitals during the COVID-19 pandemic. Two hundred and thirty-six
NHS staff participated, but early trial closure due to the pandemic meant that some results were unavailable. For the primary feasibility outcomes, although recruitment rates of around 8% were lower than anticipated, half of staff screened needed referral for further health care and one-third reported intending to attend. Staff felt that the clinic addressed an important health need. The Trial Oversight Committee recommended proceeding to a full-scale trial but with modifications to address findings from the process evaluation, including ways to encourage a wider group of NHS staff to take part.