Collaborative care in the United Kingdom

Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation

PURPOSE

The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level.

METHOD

A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether.

RESULTS

The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave.

CONCLUSIONS

People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.

Inequalities in the provision and monitoring of primary care counselling: views from Wiltshire, England

This study reviewed the provision of counselling services through 30 general practices in Wiltshire, a rural county in South West England, by means of a postal questionnaire, which had an 80% response rate, and interviews with key stakeholders. While 83% of general practices had a practice-based counsellor and 87% referred patients to counselling agencies, significant inequities were identified across the area for the level of counselling provision. Systems for the monitoring, management and evaluation of counselling services were found to be inadequate and concerns were raised regarding the absence of standardised practice guidelines. These findings lend support to the Government's intention to pursue statutory regulation of psychotherapists, counsellors and related groups working in the NHS.