A Work-Related Health Check to Identify the Need for Rehabilitation and Preventive Care (Check-Up 45+): A Multicenter Randomized Controlled Trial in General Practice (PReHa45).

Abstract

Background: General practitioners are the main mediators of rehabilitation and prevention services for their patients, yet many who could benefit from such services do not receive them because there has not, to date, been any structured means of detecting need. We studied the efficacy of a work-related health check for persons aged 45 and over ("check-up 45+") to identify the need for rehabilitation and preventive care in general practice.

Methods: In a pragmatic, multicenter, 1:1 randomized controlled trial (registration no. DRKS00028303), the participating patients (aged 45 to 59) received, in addition to usual care, either a short questionnaire alone (695 patients) or, additionally, the "check-up 45+" (706 patients), in which the need for rehabilitation or prevention services was assessed with a validated "screening 45+" questionnaire and subsequent evaluation by the general practitioner. The primary endpoint was the number of applications for rehabilitation and prevention services, as determined from routine data derived from the German Pension Insurance (Deutsche Rentenversicherung). The secondary endpoints were approvals of services, actual provision of services, and needs identified by the "check-up 45+".

Results: Applications for rehabilitation and prevention services were four times more common for patients who received the "check-up 45+" than for those who did not (12.0% vs. 2.9%; p<0.001). The percentages of approved and completed services were higher as well (8.4% vs. 2.4%; 7.2% vs. 2.3%; p<0.001 for both). The "checkup 45+" identified a need for rehabilitation in 17.7% of patients and a need for preventive services in 26.3%.

Conclusion: These findings indicate that the use of the "check-up 45+" in primary care increases the number of applications for rehabilitation and prevention services. The "check-up 45+" can improve needs-based access to rehabilitation and prevention services through early, structured recognition of the patient's needs and ensuing application for these services.