Interpretation of findings
anxiety, CMD illness, ’, CMD, depression, stress-related mental disorder
SAID
The results of the trial indicate that providing more intense contacts with care and the workplace for patients with CMD, with a symptom burden and reduction in WAI high enough to cause need of sick leave, did not lead to earlier return to full time work participation compared with the usual level of support to the patient provided by the care manager in a collaborative care organisation together with access to psychological and other therapeutic competences at the PCC. It seems that it is not possible to hurry up the processes that these patients need. Building a person-centred care process based on accessibility, continuity and close contact with a care manager makes it possible to adjust the care and timing to the individual patent’s needs. The level of support and care that the care manager provides for the patient during the initial 3 months of the CMD illness seems ‘good enough’. Extra care efforts on top of this, as provided in this intervention, do not seem to improve the patient’s state. It is possible that a more thorough dialogue with greater competency is needed or, alternatively, repeated meetings to achieve a faster RTW. The person-centred dialogue meeting may achieve a better understanding on the part of the employer for the worker’s health situation but a change in the work situation might not be possible anyway.RCT trials have shown effectiveness of collaborative care and care management in patients with depression, and the CO-WORK-CARE trial further develops the collaborative care/care manager intervention with structured early cooperation between the PCC competencies, including the GP and rehabilitation personnel, and patients on sick leave because of depression, anxiety and stress-related mental disorder. Care management was the basis of care in both arms, while the early and structured cooperation among the care manager, rehabilitation coordinator and the GP coupled with the person-centred dialogue meeting with employer the was the added value of the intervention. The effects of the structured cooperation were only discernible on the patient level. Early and structured cooperation coupled with a dialogue meeting can thus be said to be more effective in the long run for patients concerning their moderate-serious depression and anxiety symptoms than usual care manager contact, but not at all more effective concerning sick leave duration. Interview studies of patients’ and personnel’s perceptions of working according to the CO-WORK-CARE model reveal that patients perceived the person-centred dialogue meeting with the employer as positive,