Development and implementation of work-oriented clinical care to empower patients with kidney disease: an adapted intervention mapping approach.

Background: Many people with chronic kidney disease (CKD) have problems to stay at work. Patients and health care professionals (HCPs) see the potential benefit of work-oriented clinical care, yet this care is not manifested in current practice. The aim of this study was to develop and implement a program called work-oriented clinical care for kidney patients (WORK) to support sustainable work participation.

Methods: An adapted version of Intervention Mapping (AIM) was used for the systematic development of work-oriented care in a hospital. Based on the needs of patients and (occupational) health professionals, and in close cooperation with both, a theoretical and empirically based program was developed. Feasibility and clinical utility were assessed among patients with CKD, HCPs and hospital managers. To increase the chances of successful implementation we focused on determinants related to the innovation, the users, the organization (hospital), and socio-political context.

Results: We developed, implemented, and pilot-tested WORK, an innovative program consisting of a care pathway in the hospital that targets patients with work-related questions and tailors the support they receive to their needs. Several practical tools were developed and an internal and external referral structure with a focus on work was implemented. A labor expert was deployed to the hospital to support patients and HCPs with simple work-related questions. The feasibility and clinical utility of WORK were rated positively.

Conclusions: This work-oriented clinical care program provides HCPs in the hospital with the necessary tools to support patients with CKD in dealing with work challenges. HCPs can discuss work with patients at an early stage and support them in anticipating work-related challenges. HCPs can also bridge the gap to more specialized help if necessary. WORK has the potential for wider application in other departments and hospitals. So far, the implementation of the WORK program was successful, though structural implementation may be challenging.