1. Difficulties to go back to work in case of common and chronic Low Back Pain Points of view of patients, of general practitioners and of National Health Service physicians Agnès NICOT (CNAMTS, ELSM 87), Philippe NICOT (UNAFORMEC), France Context Frequent and major problem of public health : Use of medical care Work absenteeism Deterioration of life quality Social and professional disability There are recommendations for the diagnosis and for the medical care Goals Describing the difficulties to return to work, using questionnaires among patients, usual physicians and National Health Service physicians Comparing answers concordance Method Qualitative cross study on a continuous random series from April 1 st, 2000 and October 2 nd, 2000 in Haute Vienne department (France). Among the 3 parties : Patients suffering from low back pains, according to the QTF, on a sick leave for more than 3 months, Usual physicians, National Health Service physicians. 3 standardized questionnaires made out of data from the literature : 1 for the patient 1 for the usual physician 1 for the National Health Service physician who controls the sick leaves Inclusions Patients still on a sick leave when filling in the questionnaire All the files containing the 3 filled in questionnaires and low back pain corresponding to the QTF criteria Elements determining the sick leave extension UPNHSP % Age03 Associated pathologies1,5 Results of the clinical examination 1815 Pain suffered by patient3048 Effects of pain in usual activities 4019 Results of complementary examinations 61,5 Patient’s request00 Difficulty to negotiate a return to work 4,50 None012 Total100 Main results The patients They are relieved by : Rest (54%) Medicine (21%) Physiotherapy (15%) Others (10%) The main reasons for not returning to work : Back pains (51%) Effects on daily activities (42%) Profession (7%) The work physician had been contacted by the patient on 38% of 87% (22/58) The patients had a work physician in 87% of the cases (58/67) The priority goal of the treatment is : To recover and go back to work (57%) To go back to an adapted job (21%) To recover (19%) To go back to work in spite of the pains (3%) The physicians For the physicians, removing the patients from their work environment was essential (67% of usual physicians, 70% National Health Service physicians). The work physician had been contacted in 25% of the cases by the other physicians (usual physician and National Health Service physician) The main therapeutic goal was : - To recover (15% of usual physicians, 21% of National Health Service physicians) - To return to the former job (8% of the usual physicians, 9% of the National Health Service physicians) - To recover and return to the former job (25% of the usual physicians and 28% of the National Health Service physicians) - To return to work in spite of the pains (6% of usual physicians, 3% of the National Health Service physicians) - To return to and adapted job (46% of usual physicians, 39% of National health Service physicians) Results of the concordance between the usual physicians’ and the National Health Service physicians’ opinions : contact with the work physician : Kappa = 0,26 (p=0,016). Main therapeutic goal : Kappa = 0,15 (p=0,018) Contradictions between the results and the recommendations Recommendations little adapted to the daily practice and to the patients’, to the physicians’ and to the decision makers’ opinions. Difference of point of view between the usual physicians and the National Health Service physicians for the same patient Discussion Conclusion The different parties should adopt a strategy of early and identical dialogue EQuiP - Brussels 2004 « From theory to practice » SFDRMG / UNAFORMEC – « Le Méliès », 261 rue de Paris – 93556 Montreuil CEDEX France Phone : +33 (0)1 43 63 80 00 – email : sfdrmg@unaformec.org