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Integration of Work-Related Care in Clinical Practice

Despite medical advances, a persistent gap remains between work participation rates for people with chronic conditions and the general population. In the Netherlands, only 55–65% of  with a chronic illness is in paid employment, compared with 73% in the entire working population (between 15 and 75 years of age). Moreover, those with chronic illness in paid employment often report more sickness absence, reduced productivity, and functional limitations. This enduring disparity signals an urgent need for targeted support to enable healthy, sustained employment

Recent Dutch policies place sustainable work participation firmly within the remit of healthcare providers—not only that of occupational or insurance physicians. Clinicians in regular healthcare settings can support patients’ work ability from early symptoms and diagnosis through recovery, enabling timely, personalised interventions. This is crucial given that about half the working population has no, or temporary, access to occupational health services.

Developing the Maastricht Work-Related Care (WRC) Intervention

Led by Professor Annelies Boonen (Rheumatology, MUMC+) and Professor Angelique de Rijk (Work and Health, Maastricht University), CAPHRI set out to design, implement, and evaluate a clinical intervention aimed at supporting people with long-term health conditions in remaining at work and avoid long-term absence.

Using the Intervention Mapping framework, the team created Maastricht Work-Related Care (WRC)—an evidence-based programme designed to encourage healthcare professionals to proactively monitor their patients’ work participation. Grounded in the trusted clinical reasoning processes, implementation of WRC is supported by tailored educational materials and training modules. Medical specialists assess the need for WRC during hospital consultations, while specialised nurses integrate practical work-related support into routine appointments.

The project follows an action research approach, with the intervention being refined through continuous collaboration and feedback from patients, clinicians, and other stakeholders.

Establishing the ‘Work and Health’ Clinic

On 14 December 2024, MUMC+ launched its dedicated “Work and Health” clinic at the Brugpoli to address complex work-related issues that go beyond the expertise of the treating specialist or nurse. Research shows that while the number of patients requiring this specialized input at the “Work and Health” clinic is small, the clinic’s existence enhances the awareness of work-related issues  and facilitates their discussion in routine care.

Nation-Wide Collaboration

Maastricht WRC fits with the nation-wide increased attention for work within regular healthcare. Different hospitals adopt slightly different models aligned with local possibilities and needs. Via the platform ‘Zorg en Werk netwerk’ researchers and clinicians exchange experiences and improve work-related care for Dutch patients. In addition, specific knowledge on health and work participation  patients with specific diseases is needed. Although many common barriers and facilitators exist among patients with chronic diseases in working age, insight into disease-specific needs is necessary. We contribute to this knowledge for patients with rheumatoid arthritis and osteoarthritis, and in collaboration with NUTRIM, for those with chronic gastro-intestinal disorders, while our colleagues from Radboud UMC focus on patients within oncology and neurology. Finally, Maastricht WRC is supported by AKAG-ZON, our regional collaboration with the Employee Insurance Agency (UWV). 

CAPHRI’s Contribution and Future Outlook

By bridging hospital care with societal needs, CAPHRI advances prevention and sustainable health while deepening its collaboration with the academic hospital. Its structured approach supports behavioural change among clinicians, guides the development of complex interventions, and ensures rigorous evaluation, including the evaluation of the health-economic impact.

Next steps include scaling WRC across all hospital departments, extending the approach to ‘1.5-line’ care (collaborative primary–secondary care), collaboration with the Department Nursing Science and the “Vitality Office’ in the MUMC+. Further, advocacy for financial of the ‘Work and Health’ Clinic and gathering robust evidence of clinical and cost-effectiveness are important assets towards sustainable work related care.  Demonstrating the economic case is essential to secure permanent funding for the small but vital investment of time needed to deliver WRC in hospital settings. 

Important Output

Research products for peers:

(Open access) Journal articles and reviews:

  • Butink M, Boonen A, Boymans T, Baadjou V, Hazelzet E, de Rijk A. A Mixed-Methods Process Evaluation of the Maastricht Work-Related Support Intervention for Healthcare Professionals in Clinical Care. J Occup Rehabil. 2025 Jun;35(2):374-389. doi: 10.1007/s10926-024-10211-0. Epub 2024 Jun 10. PMID: 38856951; PMCID: PMC12089242.
  • Butink M, Boekel L, Boonen A, de Rijk A, Wolbink G, Webers C. Work participation and the COVID-19 pandemic: an observational study in people with inflammatory rheumatic diseases and population controls. Rheumatol Adv Pract. 2024 Mar 9;8(2):rkae026. doi: 10.1093/rap/rkae026. PMID: 38566834; PMCID:PMC10987210.
  • Butink M, Hooper S, Boonen A, Baadjou V, Boymans T, Pierik M, de Rijk A. Optimizing the Maastricht Work-Related Support intervention in clinical patient care: the value of integrating action research into intervention mapping. BMC Health Serv Res. 2024 Mar 11;24(1):325. doi: 10.1186/s12913-024-10752-3. PMID: 38468294; PMCID: PMC10929078.
  • Butink M, Dona D, Boonen A, Peters M, Baadjou V, Senden T, de Rijk A. Work-related support in clinical care for patients with a chronic disease: development of an intervention. J Occup Rehabil. 2022 Dec;32(4):705-717. doi: 10.1007/s10926-022-10032-z. Epub 2022 May 20. Erratum in: J Occup Rehabil. 2023 Mar;33(1):226. doi: 10.1007/s10926-022-10053-8. PMID: 35596102; PMCID: PMC9668761.
  • Butink MHP, Webers C, Verstappen SMM, Falzon L, Betteridge N, Wiek D, Woolf AD, Stamm TA, Burmester GR, Bijlsma JWJ, Christensen R, Boonen A. Non-pharmacological interventions to promote work participation in people with rheumatic and musculoskeletal diseases: a systematic review and meta-analysis from the EULAR taskforce on healthy and sustainable work participation. RMD Open. 2023 Jan;9(1):e002903. doi: 10.1136/rmdopen-2022-002903. PMID: 36596655; PMCID: PMC10098260.
  • van der Burg LRA, van Kuijk SMJ, Ter Wee MM, Heymans MW, de Rijk AE, Geuskens GA, Ottenheijm RPG, Dinant GJ, Boonen A. Long-term sickness absence in a working population: development and validation of a risk prediction model in a large Dutch prospective cohort. BMC Public Health. 2020 May 15;20(1):699. doi: 10.1186/s12889-020-08843-x. PMID: 32414410; PMCID: PMC7227258
  • Lemlijn‐Slenter, A. H., van Iperen, L. P., Wijnands, K. A., Wolter, N., de Rijk, A. E., & Masclee, A. A. (2025). Is Health Status in Patients With Chronic Disorders of the Gastrointestinal System Disease‐Specific? Results From an Integral Approach. Neurogastroenterology & Motility, e15021.
  • Lemlijn-Slenter, A. H., Wijnands, K. A., van der Hamsvoort, G., van Iperen, L. P., Wolter, N., de Rijk, A. E., & Masclee, A. A. (2024). Positive health: An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders. World Journal of Gastroenterology, 30(28), 3418.
  • Lemlijn-Slenter AHWM, Wijnands KAP, de Rijk A, Masclee AAM. Mapping positive health in patients with gastrointestinal disorders. BMJ Open 2021; 11: e052688
  • Capelusnik D, Smeets W, Webers C, Ramiro S, Nikiphorou E, Braekers R, Boekel L, Wolbink G, Boonen A. Reference intervals of work ability and productivity loss and their use in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open. 2025 Jan 6;11(1):e004877. doi: 10.1136/rmdopen-2024-004877.
  •  Capelusnik D, Ramiro S, Nikiphorou E, Maksymowych WP, Magrey MN, Marzo-Ortega H, Boonen A. Thresholds for unacceptable work state in radiographic axial spondyloarthritis of four presenteeism and two clinical outcome measurement instruments. Rheumatology (Oxford). 2025 Jan 1;64(1):358-366. doi: 10.1093/rheumatology/keae033.

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