360 The implementation of clinical guidelines concerning return to work after myocardial infarction

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ObjectivesThe clinical guidelines concerning return to work after myocardial infarction (MI) were published in Israel on 2003. These guidelines were further published in the local medical association journal, Harefua, 2007. Our purpose was to examine the implementation of these guidelines by Occupational Physicians (OP).MethodsIn this retrospective study, we analysed medical records of patients diagnosed with recent MI. We collected medical records data on 3 populations:before the publication (2000–2003);after the first publication (2004–2007) andfollowing the review article publication (2008–2011).ResultsWe found improvement in medical history records on the following parameters: documenting years of education (18%, 45%, 56%, p<0.001); occupation (87%, 98%, 100%, p<0.001); length of hospitalisation (80%, 95%, and 94%, p<0.001); complications during hospitalisation (24%, 69%, 73%, p<0.001); comorbidities (65%, 94% and 97%, p<0.001); NYHA classification (70%, 81%, and 92%, p<0.001); and the scope of stress test (51%, 79%, and 89%, p<0.001); all of the above parameters correspond to populations 1, 2 and 3 respectively. When it came to determining working capacity and recommendation of sick leave, we found a weak correlation with different parameters, with no significant difference between populations.ConclusionsThis is the first study, which evaluates the implementation of clinical guidelines using clinical variables taken from medical records, and over a period of 12 years. Most of the required parameters based on the guidelines were collected indicating a good implementation. However, we found a weaker implementation concerning sick leave guidelines. We assume that more resources and activity are needed in order to achieve better compliance.

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