Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work <6 months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n = 158) had fewer days work absence compared with the control arm (n = 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99), P = 0·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.
Provision of vocational advice in primary care significantly reduced days absent over 4 months in patients consulting with musculoskeletal pain and was cost effective.
aFaculty of Medicine and Health Sciences, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
bKeele Clinical Trials Unit, Keele University, Staffordshire, United Kingdom
cHealth Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
dIMPACT Service, Haywood Hospital, Stoke-on-Trent, United Kingdom
eCentre for Applied Research in Health, University of Huddersfield, Huddersfield, United Kingdom
Corresponding author. Address: Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom. Tel.: +44 (0) 1782 733962; fax: + 44 (0) 1782 733911. E-mail address: email@example.com (G. Wynne-Jones).
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Received May 23, 2017
Received in revised form September 14, 2017
Accepted September 18, 2017