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[Coronary intervention and occupational rehabilitation--a prospective, randomized intervention study]
1Städtische Kliniken Esslingen Fachbereich Kardiologie Hirschlandstr. 97 73730 Esslingen a.N., Germany. andreas.pfund@nikocity.de
Insights
Providing specific information to patients and doctors after coronary catheter revascularisation does not speed up return to work. Return-to-work delays appear linked to social and psychological factors, not information gaps.
Area of Science:
- Cardiology
- Health Economics
- Occupational Health
Background:
- Coronary catheter revascularisation is cost-effective compared to bypass surgery, but prolonged sick leave increases indirect costs.
- Delayed return to work after coronary interventions significantly elevates indirect costs, often exceeding direct medical expenses.
- Current practices may not adequately address factors influencing patient reintegration into the workforce post-procedure.
Purpose of the Study:
- To investigate if providing specific information to patients and their family doctors accelerates return to work after coronary catheter revascularisation.
- To assess the impact of targeted information on reducing sick leave duration and improving return-to-work rates.
Main Methods:
- A prospective randomised study involving 100 working patients undergoing coronary catheter revascularisation.
- Patients were allocated to either an intervention group (receiving specific information) or a control group (no specific information).
- Return-to-work rates and sick leave durations were compared between groups at four months post-procedure.
Main Results:
- No significant difference was observed in return-to-work rates or sick leave duration between the intervention and control groups.
- Patients with private insurance returned to work significantly faster (mean sick leave 5.7 days) than those with panel insurance (mean sick leave 23.7 days).
- The study found no statistically significant effect of specific information on the time patients stayed out of work.
Conclusions:
- Specific information provided to patients and family doctors does not influence the time to return to work after coronary catheter revascularisation.
- Delayed return to work appears to be influenced by social and psychological factors rather than a lack of procedural information.
- Further research into social and psychological determinants of return-to-work is warranted for patients undergoing coronary interventions.
Abstract:
Coronary catheter revascularisation is less costly than bypass surgery due to lower direct (medical) and indirect costs (loss of work). Many studies show that the time patients stay out of work following coronary intervention is much longer than necessary. This leads to a considerable increase of indirect costs, which can far exceed the medical costs of the treatment. This prospective randomised study was done to determine whether specific information to patient and family doctor results in an earlier return to work. After catheter revascularisation 100 working patients (mean age 52.4 years) were randomised either to the intervention group (information to patient and family doctor) or to the control group (no specific information about return to work). Four months later 81 patients had returned to their previous jobs (mean sick leave 18.9 +/- 24.8 days) while 19 were still out of work. In the control group, the rate was 79% and the mean sick leave was 16.4 +/- 22.0 days (median 7); in the intervention group 83% had returned to work after a mean of 21.5 +/- 27.4 days (median 10). There was no significant difference between the two groups, neither according to the rate of returned workers nor to the duration of sick leave. In the subgroup of patients with a private insurance (23% of all) 96% started to work again (mean sick leave 5.7 +/- 5.1 days median 3.5), while the rate was 77% in the group of panel patients (mean sick leave 23.7 +/- 27.4 days, median 11). The difference in sick leave between these two groups was highly significant (p = 0.0003). Specific information to the patient and family doctor has no effect on the time patients stay out of work following catheter revascularisation. It seems that the observed delay depends on social and psychological factors that cannot be influenced directly.