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Table 3 Overview of (partly) tested solutions to address barriers to using the guideline on mental health problems

From: Occupational physicians’ perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: analysis of a peer group training

1. Providing information about guideline and guideline-related tools
 • Providing information about the guideline by trainer or peers
 • Providing information about or referring to the availability of tools to improve guideline usage such as:
  - Digital version of the guideline
  - Relevant website such as (website with information and tools on psychological disorders and fatigue complaints at work)
  - Relevant related guidelines and knowledge documents, such as ‘the NVAB guide for Referring’ and ‘the knowledge document STECR’ (a working guide to deal with conflicts at work).
  - Relevant courses, such as the E-course MUPS (SOLK in Dutch)
  - Relevant surveys, such as UBOS survey (burnout)
  - Intervention tools available on G-drive of the OHS computer system
  - Information letter for patients from the NHG
  - Information letter for employers from the NVAB
2. Sharing experiences, tips and tricks
 • Exchanging experiences in group(s) on the advantages or disadvantages of working in accordance with (certain parts of) the guideline, guideline related tools and reporting in medical files.
 • Sharing tips and tricks in group, such as not accepting too tight contracts from employers, referring patients to psychiatrists with (trans)cultural expertise, tips and tricks on how to document adequately in medical files, how to use the 4DSQ (4DKL in Dutch), how to deal with suicide.
3. Presenting and discussing worker case studies
 • Presenting one or more complex or successful (anonymized) worker case studies in the group and explain how they have dealt with this while other OPs provide feedback.
4. Reading and discussing peer OPs’ reporting in medical files
 • Reading (anonymized) medical files of peer OPs and provide feedback.
5. Developing and adjusting tools to improve guideline usage
  • Developing a format to structure the worker interview, adjusting it to individual needs and discussing ways to implement it in practice (place format on desktop, add a checklist to the format, add the format to the fan-shaped tool)
  • Developing the 4DSQ tool in a digital excel version with an automatic calculation module
  • Creating a book with cognitive-behavioral interventions to be used during consultation, all invented or collected by the OPs and put together in a book
  • Creating a power-point presentation to educate employers or broader work-context
  • Creating a referral list with healthcare providers that OPs within the group recommend
  • Adjusting the fan-shaped tool with a summary of the guideline to include the format
→ Digital toolbox: creating an individual digital toolbox with a combination of above interventions as preferred by individual OPs
6. Other solutions (partly tested)
 • Creating adequate (working) arrangements with respect to communication, reporting and feedback between OPs and psychologists
 • Setting minimal standards for reporting for psychologists
 • Initiating group conversations with worker, employer, psychologist and OP
 • Organizing meetings for both psychologists and OPs to discuss the guideline on mental health problems
  1. NVAB Netherlands Society of Occupational Physicians (NVAB in Dutch), MUPS Medically Unexplained Physical Symptoms (SOLK in Dutch), UBOS Utrecht Burnout Scale, OHS occupational health service, NHG Dutch College of General Practitioners (NHG in Dutch), 4DSQ Four Dimensional Symptom Questionnaire (4DKL in Dutch), OP(s) occupational physician(s)