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ots-News: English

Work capability assessments: making them more consistent

03.07.2019 | 08:00 Uhr | Ressort: Economy | Quelle: Presseportal


Bern (ots) - On behalf of social security institutions,
psychiatrists assess to what extent people with mental health
problems are still able to work. However, the work capability
assessments tend to be far too dissimilar. A new training course,
conducted within the scope of an SNSF-funded study, has helped to
reduce the differences.

People who cannot work full-time anymore because of mental health
problems are entitled to a benefit. The amount they receive depends
on how fit for work psychiatrists consider them to be. Ideally,
psychiatrists who undertake work capability assessments should
recommend similar work quotas for similar cases, but the reality
still lags a long way behind. Sometimes assessments differ by one
hundred per cent. Needless to say, this is an unsatisfactory
situation for lawyers, judges, insurances and psychiatrists alike.

With the aid of a new type of evaluation, the functional
assessment of work capability, and special training for
psychiatrists, researchers have been able to achieve more consistent
assessments of the remaining work capability. The project, funded by
the Swiss National Science Foundation (SNSF), the Federal Social
Insurance Office and the Swiss Accident Insurance Fund (suva)
accident insurance, was able to reduce the statistical dispersion by
more than a fifth. However, practitioners want to see substantially
less deviation. On the other hand, both the applicants and the
psychiatrists involved consider the new functional assessment process
to be fair and transparent. "This is important, because the
assessments decide the fate of individuals," says the study leader
Regina Kunz from the University Hospital Basel. The study was
published in BMC Psychiatry (*).

Focusing on work

In the new evaluation process, psychiatrists focused on work as
soon as the conversation is started, rather than on the illness.
Their approach was solution-focused. For example, they asked what
activities the applicant's last job involved, what they were still
capable of doing and what might be helpful. Finally, they had to
grade 13 work-related abilities that are often compromised in people
with mental health problems. Based on this, they estimated the amount
of work someone could do.

The study included comparing assessments by 35 psychiatrists. They
assessed the work capability of 40 applicants. The conversations were
recorded on video and reviewed independently by three further
psychiatrists. In the end, four different assessments were available
for each applicant. The differences between the assessments were
compared with a previous round of assessments, in which 19 experts
had assessed the work capability of 30 applicants. This round had
been preceded by a training course for the psychiatrists which had
been considerably shorter and had moreover taken place more than a
year before the assessment.

Sights set too high?

The researchers counted how many times two assessments differed by
a maximum of 25 percentage points in their estimation of work
capability: in the control group 39 per cent of the comparisons
between two assessments were above this threshold. After the
training, the share was reduced to 26 per cent. A statistically
significant effect.

In order to gauge the tolerance limit for deviations between two
assessments of the same person in practice, the researchers had
already conducted a survey among 700 experts in Switzerland:
psychiatrists, representatives of social security institutions,
lawyers and judges. An analysis of the survey results suggested that
a difference of 25 percentage points was regarded as just about
acceptable for a process that ought to be as fair as possible (**).
"Of course we never expected our approach to solve all of the
problems," says study leader Kunz. "But we are nevertheless
disappointed that the assessments could not be made more consistent."

Kunz still feels the project has been worthwhile on the whole:
"The applicants and psychiatrists involved were satisfied with the
new process, so insurers and courts can now work with clearer and
more transparent assessments." In a follow-up study, she and her
colleagues would like to test whether further improvement is possible
if the psychiatrists receive even more intensive training.

However, the results are not likely to fulfil the expectations of
the stakeholder groups. The problem of wide variation is endemic to
the western world, as the researchers showed in a previously
published systematic review (***). "Doctors are not experts on work,
as they will willingly admit," says Kunz. "Training alone will not be
enough." It is necessary to change tack, for example by using
completely new evaluation systems: "In the Netherlands, psychiatrists
focus on therapy, the assessments are done by specially trained
experts."

(*) R. Kunz et al.: The reproducibility of psychiatric evaluations
of work disability: Two reliability and agreement studies. BMC
Psychiatry (2019). DOI: 10.1186/s12888-019-2171-y
https://doi.org/10.1186/s12888-019-2171-y

(**) S. Schandelmaier et al.: Attitudes towards evaluation of
psychiatric disability claims: a survey of Swiss stakeholders. Swiss
Medical Weekly (2015). DOI: 10.4414/smw.2015.14160
https://doi.org/10.4414/smw.2015.14160

(***) J. Barth et al.: Inter-rater agreement in evaluation of
disability: systematic review of reproducibility studies. BMJ (2017).
DOI: 10.1136/bmj.j14 https://doi.org/10.1136/bmj.j14

The text of this press release and further information are
available on the website of the Swiss National Science Foundation: ht
tp://www.snf.ch/en/researchinFocus/newsroom/Pages/news-190703-MM-work
-capacity-assessmentes-making-them-more-consistent.aspx



Contact:
Prof. Regina Kunz
Departement Klinische Forschung
Universitätsspital Basel
Phone: +41 61 328 75 67
E-Mail: regina.kunz@usb.ch