Presentation M O17

M O17 (Oral Presentation):
A multidisciplinary care program to enhance recovery and return to work following benign gynecological surgery

Presented by: Esther Vivienne Angelique Bouwsma


Bouwsma EVA1,2,3, Vonk Noordegraaf A1,2,3, Brölmann HAM2,3, Huirne JAF2,3, Anema JR1,3

  1. Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
  2. Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
  3. EMGO Institute for Health and Care Research, Amsterdam, the Netherlands



Recovery after gynaecologic surgery takes much longer than expected. Prolonged sick leave is associated with poorer quality of health, but also causes a significant financial burden on society due to high costs associated with productivity loss. We developed an innovative care program aimed at optimizing patient education and stimulating the collaboration between clinical and occupational care. The program consists of two steps: (1) an e-health intervention providing tailored evidence-based convalescence advice for all patients, and (2) an occupational intervention for those patients at risk for prolonged sick leave, targeting attitudes and (irrational) believes towards recovery. The e-health intervention has been proven effective in accelerating return to work (RTW) in a previous trial among 215 patients (HR=1.43 [95%CI=1.003-2.037]). In the current study, the care program will be subjected to an economic evaluation.


We conducted a cluster randomized controlled trial with a stepped wedge approach. Between October 2011 and June 2013, the care program was sequentially implemented in 9 teaching hospitals in the Netherlands. Participating patients undergoing gynecological surgery in one of these hospitals received either usual care or the care program, depending on the implementation phase of the hospital. Patients were followed during 12 months by means of electronic questionnaires and monthly sick leave diaries. The primary outcome was the duration until full sustainable RTW.


In total, 433 patients are included in this study; 227 in the intervention and 206 in the control group. In the intervention group the vast majority of patients logged in to the webportal at least once (91.6%). Of eligible patients, 75.9% received a consultation with a clinical occupational physician. Preliminary descriptive analyses are promising: the difference in duration until full RTW between the two study arms is a minimum of 2 weeks, in favor of the care program. Further analyses will take place in June 2014, when follow-up is completed. Final results will be available during the conference.


The cost-effectiveness of the care program under study is potentially very high, with considerable impact. The results of this study will enable health care policy makers to decide about future implementation of this care program.

Schedule Details

Monday September 29
13:45 - 15:15 Afternoon Concurrent Sessions (M O13 - M O24 and Seminar 2)
Session: Healthcare providers’ interventions I
Room B