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Löfgren M, Törnbom K, Gyllenhammar D, Nordeman L, Rembeck G, Björkelund C, Svenningsson I, Hange D. Professionals' experiences of what affects health outcomes in the sick leave and rehabilitation process-A qualitative study from primary care level. PLoS One 2024; 19:e0306126. [PMID: 39074087 DOI: 10.1371/journal.pone.0306126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/10/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE To explore frontline employees' experiences of how to create a purposeful sick leave and rehabilitation process (SRP) with the best interest of patients' long-term health in focus. METHODS Qualitative design based on focus group interviews in a primary care context in Region Västra Götaland, Sweden. Strategically selected professionals from different SRP organizations discussed sick leave outcomes and the rehabilitation process. Analysis was performed with Systematic text condensation. SUBJECTS General practitioners (n = 6), rehabilitation coordinators and/or healthcare professionals from primary healthcare (n = 13), caseworkers from the Social Insurance Agency, the Employment Agency, and Social Services (n = 12). RESULTS The outcome of the SRP was described to depend upon the extent to which the process meets patients' bio-psycho-social needs. Aspects considered crucial were: 1) early bio-psycho-social assessments, including medical specialist consultations when needed, 2) long-term realistic planning of sick leave and rehabilitation alongside medical treatment, 3) access to a wide range of early rehabilitative and supportive interventions, including situation-based, non-medical practical problem solving, and 4) trusting relationships over time for all involved professions and roles to maximize process quality and person-centeredness. A gap between the desired scope of the SRP and existing guidelines was identified. CONCLUSION Interviewees perceived that successful outcomes from the sick leave and rehabilitation process in a primary care context depend on consensus, person-centeredness, and relationship continuity for all involved professions. An extended process scope and relationship continuity for all involved professionals were suggested to improve process outcomes.
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Affiliation(s)
- Märit Löfgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
| | - Karin Törnbom
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Gyllenhammar
- Department of Technology Management and Economics, Centre of Healthcare Improvements, Chalmers University of Technology, Gothenburg, Sweden
| | - Lena Nordeman
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Rembeck
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Södra Älvsborg, Sweden
- Regional Health, Youth Guidance Center, Borås, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Sweden
| | - Irene Svenningsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Fyrbodal, Sweden
| | - Dominique Hange
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Sweden
- Region Västra Götaland, Research, Education, Development & Innovation Primary Health Care, Research, Education, Development & Innovation Center Skaraborg, Sweden
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Saunders B, Chew-Graham C, Sowden G, Cooke K, Walker-Bone K, Madan I, Parsons V, Linaker CH, Wynne-Jones G. Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. Health (London) 2024; 28:185-202. [PMID: 37092765 PMCID: PMC10900846 DOI: 10.1177/13634593221148446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.
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Affiliation(s)
- Benjamin Saunders
- Benjamin Saunders, School of Medicine, Keele University, Staffordshire ST55BG, UK.
| | | | | | | | | | | | - Vaughan Parsons
- King’s College London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, UK
- University of Southampton, UK
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Yanar B, Kosny A, Lifshen M. Perceived Role and Expectations of Health Care Providers in Return to Work. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:212-221. [PMID: 29948470 DOI: 10.1007/s10926-018-9781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Health care providers (HCPs) play an important role in return to work (RTW) and in the workers' compensation system. However, HCPs may feel unsure about their responsibilities in the RTW process and experience difficulty making recommendations about RTW readiness and limitations. This study examines the ways in which HCPs and case managers (CMs) perceive HCPs role in the RTW process, and how similarities and differences between these views, in turn, inform expectations of HCPs. Methods In-depth interviews were conducted with 69 HCPs and 34 CMs from 4 provinces. Data were double coded and a thematic, inductive analysis was carried out to develop key themes. Findings The main role of HCPs was to diagnose injury and provide patients with appropriate treatment. In addition, the majority of HCPs and CMs viewed providing medical information to workers' compensation board (WCB) and the general encouragement of RTW as important roles played by HCPs. There was less clarity, and at times disagreement, about the scope of HCPs' role in providing medical information to WCB and encouraging RTW, such as the type of information they should provide and the timelines for RTW. Conclusion Interviews suggest that different role expectations may stem from differing perspectives of HCPs and the CMs had regarding RTW. A comprehensive discussion between WCB decision-makers and HCPs is needed, with an end goal of reaching consensus regarding roles and responsibilities in the RTW process. The findings highlight the importance of establishing clearer role expectations.
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Affiliation(s)
- Basak Yanar
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada.
| | - Agnieszka Kosny
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Marni Lifshen
- Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada
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Michiels-Corsten M, Bösner S, Donner-Banzhoff N. Individual utilisation thresholds and exploring how GPs' knowledge of their patients affects diagnosis: a qualitative study in primary care. Br J Gen Pract 2017; 67:e361-e369. [PMID: 28396368 PMCID: PMC5409439 DOI: 10.3399/bjgp17x690509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/24/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND One of the tenets of general practice is that continuity of care has a beneficial effect on patient care. However, little is known about how continuity can have an impact on the diagnostic reasoning of GPs. AIM To explore GPs' diagnostic strategies by examining GPs' reflections on their patients' individual thresholds for seeking medical attention, how they arrive at their estimations, and which conclusions they draw. DESIGN AND SETTING Qualitative study with 12 GPs in urban and rural practices in Germany. METHOD After each patient consultation GPs were asked to reflect on their diagnostic reasoning for that particular case. Qualitative and quantitative analyses of consultations and interview content were undertaken. RESULTS A total of 295 primary care consultations were recorded, 134 of which contained at least one diagnostic episode. When elaborating on known patients, GPs frequently commented on how 'early' or 'late' in an illness progression a patient tended to consult. The probability of serious disease was accordingly regarded as high or low. This influenced GPs' behaviour regarding further investigations or referrals, as well as reassurance and watchful waiting. GPs' explanations for a patient's utilisation threshold comprised medical history, the patient's characteristics, family background, the media, and external circumstances. CONCLUSION The concept of an individual threshold for the utilisation of primary care would explain how GPs use their knowledge of individual patients and their previous help-seeking behaviour for their diagnostic decision making. Whether the assumption behind this concept is valid, and whether its use improves diagnostic accuracy, remains to be investigated.
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Affiliation(s)
- Matthias Michiels-Corsten
- Department of General Practice/Family Medicine, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Stefan Bösner
- Department of General Practice/Family Medicine, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Faculty of Medicine, University of Marburg, Marburg, Germany
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Coole C, Nouri F, Potgieter I, Drummond A. Completion of fit notes by GPs: a mixed methods study. Perspect Public Health 2015; 135:233-42. [PMID: 26194137 DOI: 10.1177/1757913915594197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to investigate the completion of fit notes by UK general practitioners (GPs). A series of actual fit notes issued to employed patients were examined, and their GPs' reflections and experiences of fit note completion explored. METHODS A mixed-methods design was used. Data were collected from copies of 94 fit notes issued to employed patients by 11 GPs, and from 86 questionnaires completed by these GPs reflecting on the fit notes they had issued. Face-to-face interviews were then conducted with each GP. RESULTS Fit note completion is not meeting expectations for a number of reasons. These include the following: limited knowledge and awareness of the guidance in fit note completion; problems with the fit note format; lack of mandatory training in completing fit notes; lack of incentive to change practice; incomplete implementation of the electronic fit note; GPs' lack of confidence in, and doubts about the appropriateness of performing this role. CONCLUSION If UK GPs are to continue their contractual responsibility for completing fit notes, further consideration of their education and training needs is urgently required. Weaknesses in the design and format of the fit note and the availability of the electronic version also need to be addressed.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, A Floor, Medical School, Queens Medical Centre, UK
| | - Fiona Nouri
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Iskra Potgieter
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Rachman R, Bunce D, Thorley K, Hendriksz J. Patients' attitudes to sickness certification in general practice. Occup Med (Lond) 2015; 65:485-8. [PMID: 26078416 DOI: 10.1093/occmed/kqv069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, the sick note was replaced with the fit note, designed to enable return to work. Despite considerable research relating to general practitioners' (GPs') attitudes and practice towards the fit note, little is known regarding the patients' perspective. AIMS We sought to identify patients' attitudes to and feelings about the process of sickness certification. METHODS Patients who received fit notes were invited to participate in tape-recorded telephone interviews, which were conducted with a semi-structured approach. Participants described their reason for sickness absence and whether it had been related to work. They were then asked to provide a narrative regarding their experience of the fitness for work process and their feelings about their GP and employer's reaction to sickness absence. RESULTS Nine patients were interviewed. Four main themes emerged from analysis of the interviews: 'significant stigma', 'a GP who knows me', 'value of work' and 'emotional barriers'. Patients expressed preference for being seen by a familiar GP with a greater perceived understanding of the patient's attitude to sickness and work. CONCLUSIONS The four emergent themes of stigma, the value of work, a doctor who knows you and emotion suggest that further research should focus on the problems of stigma associated with sickness certification and patients' emotional response to asking for certification.
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Affiliation(s)
- R Rachman
- Peninsula School of Medicine and Dentistry, Plymouth, Devon PL6 8BU, UK
| | - D Bunce
- South Devon Healthcare Trust, Torbay Hospital, Lowes Bridge, Torquay, Devon TQ2 7AA, UK
| | - K Thorley
- Lostwithiel Medical Centre, Lostwithiel, Cornwall PL22 0EF, UK.
| | - J Hendriksz
- Lostwithiel Medical Centre, Lostwithiel, Cornwall PL22 0EF, UK
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Wheat HC, Barnes RK, Byng R. Practices used for recommending sickness certification by general practitioners: A conversation analytic study of UK primary care consultations. Soc Sci Med 2015; 126:48-58. [DOI: 10.1016/j.socscimed.2014.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ter Haar M, Aarts N, Verhoeven P. Finding common ground in implementation: towards a theory of gradual commonality. Health Promot Int 2014; 31:214-30. [PMID: 25209917 DOI: 10.1093/heapro/dau077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article reports on an empirical study that aimed to design a practice-based theory about collaboration on the local implementation of a nationally developed health-promoting intervention. The study's objective is to better understand the dynamic process of complex collaboration. The research is based on a Delphi study among some 100 individuals in local and regional networks, in which various professionals work together to implement the BeweegKuur, which translates as 'course of exercise'. The BeweegKuur is a combined lifestyle intervention aimed at promoting sufficient physical exercise and a healthy diet among people in the Netherlands who are overweight and at risk of diabetes. The Delphi study in three rounds systematically and interactively constructs a common perspective on implementation, reflecting stakeholders' ideas about the collaboration and providing an insight into how these ideas are influenced by the context of the implementation. The statistical and qualitative analyses of the responses to the feedback in the Delphi study form the basis for this practice-based theory on complex collaboration, called the theory of gradual commonality. During interaction, consensus gradually emerges about co-creation as a collaboration strategy. Co-creation leaves room for various ways of achieving the ambitions of the BeweegKuur. This article discusses the importance of this practice-based theory and the value of the Delphi research strategy for promoting health.
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Affiliation(s)
- Marian Ter Haar
- Netherlands Institute for Sport & Physical Activity, Ede, the Netherlands
| | - Noelle Aarts
- ASCoR (Amsterdam School for Communication Research), University of Amsterdam, Amsterdam, the Netherlands; Strategic Communication Group, Wageningen University, Wageningen, the Netherlands
| | - Piet Verhoeven
- ASCoR (Amsterdam School for Communication Research), University of Amsterdam, Amsterdam, the Netherlands
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Letrilliart L, Barrau A. Difficulties with the sickness certification process in general practice and possible solutions: A systematic review. Eur J Gen Pract 2012. [DOI: 10.3109/13814788.2012.727795] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yano EM, Green LW, Glanz K, Ayanian JZ, Mittman BS, Chollette V, Rubenstein LV. Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum. J Natl Cancer Inst Monogr 2012; 2012:86-99. [PMID: 22623601 DOI: 10.1093/jncimonographs/lgs004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability.
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Affiliation(s)
- Elizabeth M Yano
- Veterans Health Administration Health Services Research & Development Center of Excellence, VA Greater Los Angeles Healthcare System, 16111 Plummer St (Mailcode 152), Sepulveda, CA 91343, USA.
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Block-Lerner J, McClure KS, Gardner FL, Wolanin AT. Unique Roles for Students in Practitioner-Focused Doctoral Programs: Mentoring Practices for an Evolving Landscape. J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.3.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies suggest that training that culminates in the doctor of psychology (PsyD) degree is characterized by heterogeneity. However, elements of most of these practitioner-focused doctoral programs (e.g., larger class sizes, shorter periods of training, less funding for students), as well as the widely varying professional outcomes that they lead to, offer unique challenges and opportunities regarding mentoring. This article aims to (a) trace the development and current status of controversies surrounding the PsyD model; (b) determine the unique roles in which graduates of well-designed and scientifically grounded PsyD programs may be equipped to serve; and (c) drawing on the (limited) extant literature, offer recommendations for mentoring and other elements of training for these practitioner-focused programs. Finally, we offer suggestions for future empirical studies to shed light on the relative value of various training practices.
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Wrapson W, Mewse AJ. Does the doctor or the patient control sick leave certification? A qualitative study interpreting patients' interview dialogue. Fam Pract 2011; 28:202-9. [PMID: 20978243 DOI: 10.1093/fampra/cmq088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sickness certification poses challenges and problems for the GP. Patient factors may influence the sick leave period. OBJECTIVE To explore how sickness certification occurred based on patients' reports of medical consultations for a new episode of low back pain. METHODS A qualitative study using semi-structured interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. RESULTS We present a preliminary typology of sickness certification responses by medical practitioners comprising four response types: 'process', 'cued', 'consultative' and 'laissez-faire'. All but the process response allows the patient some influence in the sickness certification decision. It is possible that certain types of response may occur at specific stages of recovery. CONCLUSIONS Doctors may allow patients input into the sickness certification process for a number of reasons. As yet, we do not know if this helps or hinders the return to work process.
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Affiliation(s)
- Wendy Wrapson
- Centre of Methods and Policy Application in the Social Sciences, The University of Auckland, Auckland 1142, New Zealand.
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Abstract
BACKGROUND GPs can find their role as issuers of sickness certification problematic, particularly in trying to maintain a balance between certifying absence and preserving the doctor-patient relationship. Little research has been published on consultations in which sickness absence has been certified. AIM To explore negotiations between GPs and patients in sickness absence certification, including how occupational health training may affect this process. METHOD A qualitative study was undertaken with GPs trained in occupational health who also participate in a UK wide surveillance scheme studying work-related ill-health. Telephone interviews were conducted with 31 GPs who had reported cases with associated sickness absence. RESULTS Work-related sickness absence and patients' requests for a 'sick note' vary by diagnosis. Some GPs felt their role as patient advocate was of utmost importance, and issue certificates on a patient's request, whereas others offer more resistance through a greater understanding of issues surrounding work and health acquired through occupational health training. GPs felt that their training helped them to challenge beliefs about absence from work being beneficial to patients experiencing ill-health; they felt better equipped to consider patients' fitness for work, and issued fewer certificates as a result of this. CONCLUSION Complex issues surround GPs' role in the sickness-certification process, particularly when determining the patient's ability to work while maintaining a healthy doctor-patient relationship. This study demonstrates the potential impact of occupational health training for GPs, particularly in light of changes to the medical statement introduced in 2010.
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Coole C, Watson PJ, Drummond A. Staying at work with back pain: patients' experiences of work-related help received from GPs and other clinicians. A qualitative study. BMC Musculoskelet Disord 2010; 11:190. [PMID: 20799938 PMCID: PMC2936348 DOI: 10.1186/1471-2474-11-190] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 08/27/2010] [Indexed: 12/02/2022] Open
Abstract
Background Low back pain commonly affects work ability, but little is known about the work-related help and advice that patients receive from GPs and other clinicians. The purpose of this study was to explore the experiences of employed people with back pain and their perceptions of how GPs and other clinicians have addressed their work difficulties. Methods A qualitative approach with thematic analysis was used. Individual interviews were carried out with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain. Results The perception of the participants was that GPs and other clinicians had provided little or no work-focused guidance and support and rarely communicated with employers. Sickness certification was the main method that GPs used to manage participants' work problems. Few had received assistance with temporary modifications and many participants had remained in work despite the advice they had received. There was little expectation of what GPs and other clinicians could offer to address work issues. Conclusions These findings question the ability of GPs and other clinicians to provide work-focused support and advice to patients with low back pain. Future research is recommended to explore how the workplace problems of patients can be best addressed by health professionals.
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Affiliation(s)
- Carol Coole
- Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Joyce KE, Smith KE, Henderson G, Greig G, Bambra C. Patient perspectives of Condition Management Programmes as a route to better health, well-being and employability. Fam Pract 2010; 27:101-9. [PMID: 19948563 DOI: 10.1093/fampra/cmp083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Condition Management Programmes (CMPs), delivered through primary care settings, have been identified as possible vehicles to facilitate return to work for individuals with chronic health problems. There is little research, however, which examines how such programmes are received by patients. OBJECTIVE To explore patients' experiences of CMPs in terms of health, well-being and employability. METHODS Four focus groups and nine semi-structured interviews were conducted in order to capture patients' (n = 25) perceptions and experiences regarding participation in one of five different CMPs: Cardiac Rehabilitation, Counselling, Lower Back Pain Services, Smoking Cessation and a GP Exercise Referral Programme. RESULTS Experiences of the CMPs were generally positive. Respondents reported improved health behaviours (specifically better diets and increased exercise), positive psychosocial outcomes (including increased self-esteem, confidence and social support) and in some cases, return to work. However, concerns were expressed about the shortness of interventions and their accessibility. CONCLUSIONS Although condition management appears to have been well received by participants, the findings also illustrate that there is no 'one size fits all' template for CMPs. Rather, interventions should be adapted to take account of the dynamics of specific conditions, the context in which the intervention is based and the characteristics of the individuals involved.
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Affiliation(s)
- K E Joyce
- Department of Geography, Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees, UK.
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van Rijssen HJ, Schellart AJM, Anema JR, van der Beek AJ. A theoretical framework to describe communication processes during medical disability assessment interviews. BMC Public Health 2009; 9:375. [PMID: 19807905 PMCID: PMC2765440 DOI: 10.1186/1471-2458-9-375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 10/06/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. OBJECTIVE The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. CONCLUSION The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments.
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