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Møller A, Bond CB, Andersen LN, Hartvigsen J, Stochkendahl MJ. General practitioners' stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program. Scand J Prim Health Care 2023; 41:445-456. [PMID: 37837433 PMCID: PMC11001345 DOI: 10.1080/02813432.2023.2268674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVES To describe current stay-at-work practices among Danish general practitioners (GPs) in relation to patients with musculoskeletal disorders, to identify potential avenues for improvement, and to suggest a training program for the GPs. DESIGN AND SETTING We followed the principles of Intervention Mapping. Data were collected by means of literature searches, focus group interviews with GPs, and interaction with stakeholder representatives from the Danish labour market. RESULTS GPs' current stay-at-work practices were influenced by systemic, organisational, and legislative factors, and by personal determinants, including knowledge and skills relating to stay-at-work principles and musculoskeletal disorders, recognition of the patient's risk of long-term work disability, their role as a GP, and expectations of interactions with other stay-at-work stakeholders. GPs described themselves as important partners and responsible for the diagnostic and holistic assessments of the patient but placed themselves on the side line relying on the patient or workplace stakeholders to act. Their practices are influenced both by patients, employers, and by other stakeholders. We propose a training course for GPs that incorporate both concrete tools and behaviour change techniques. CONCLUSIONS We have identified varied perspectives on the roles and responsibilities of GPs, as well as legislative and organisational barriers, and proposed a training program. Not all barriers identified can be addressed by a training course, and some questions are left unanswered, among others - who are best suited to help patients staying at work?
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Affiliation(s)
- A. Møller
- Research Unit for General Practice in Copenhagen, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C. B. Bond
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - L. N. Andersen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J. Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - M. J. Stochkendahl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Berglund E, Friberg E, Engblom M, Svärd V. Physicians' experience of and collaboration with return-to-work coordinators in healthcare: a cross-sectional study in Sweden. Disabil Rehabil 2023:1-9. [PMID: 37772755 DOI: 10.1080/09638288.2023.2261851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians. The aim of this study was to explore physicians' experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics. MATERIALS AND METHODS Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs. RESULTS Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RTWCs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06-4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification. CONCLUSIONS Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs' facilitation of contacts with RTW stakeholders and improvements in the sickness certification process may be of importance for physicians.Implications for RehabilitationThis study of physicians' experience of collaborating with return-to-work coordinators (RTWCs) observes that physicians reported more collaboration with or referrals to coordinators if they had a favourable experience of coordinators.The results indicate that physicians report more collaboration with or referrals to RTWCs if they had more problematic sick-leave cases to handle in the clinic.These findings imply that it might be possible to increase the collaboration between physicians and RTWCs in clinical settings by managing factors of importance.
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Affiliation(s)
- Erik Berglund
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emilie Friberg
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Monika Engblom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Svärd
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
- Department of Social Sciences, Division of Social Work, Södertörn University, Huddinge, Sweden
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Drolet L, Caron PO, Forget J, Turcotte JR, Guimond C. Family physicians' sick-listing practices in relation to mental disorders: A descriptive study. Work 2022; 75:211-221. [PMID: 36591671 DOI: 10.3233/wor-211301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mental disorders are among the leading causes of disability for which family physicians are often required to complete sickness certificates. Yet, little is known about family physicians' sick-listing practices in Quebec. OBJECTIVE This study aims to describe their practices, difficulties and needs. METHODS Twenty-three family physicians completed a comprehensive questionnaire on sickness certification practices. Descriptive statistics were used. RESULTS Despite being completed on a weekly basis, sickness certifications were deemed problematic by all participants. While they rarely refused to sick-list a patient, 43.5% reported suggesting accommodations as an alternative to sick leave. Waiting-time to access psychotherapy and delays to set-up workplace accommodations are responsible for many unnecessary sick-leave prolongations. Lack of time, long duration absences, situations where the physician held a different opinion than the patient/healthcare provider and assessing an individual's capacity to work are the most common reported problems. More than half of participants indicated medical schools do not greatly prepare them to carry out these tasks. CONCLUSION Sickness certifications are deemed problematic, and more training might be key. Our results can be used by medical schools or bodies responsible for continuous education to improve training.
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Affiliation(s)
| | | | | | | | - Claude Guimond
- Fédération des Médecins Omnipraticiens du Québec, Quebec, QC, Canada
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Kadowaki Å, Alvunger AK, Larsen HI, Persdotter A, Zak MS, Johansson P, Nystrom FH. Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial. BMC FAMILY PRACTICE 2021; 22:179. [PMID: 34496751 PMCID: PMC8428055 DOI: 10.1186/s12875-021-01526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Abstract
Background The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas. Results The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24). Conclusions Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality. Trial registration Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01526-5.
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Affiliation(s)
- Åsa Kadowaki
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna-Karin Alvunger
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Hanna Israelsson Larsen
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Persdotter
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Marta Stelmach Zak
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik H Nystrom
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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Psychiatrists' Experience of Vocational Rehabilitation for Patients with Mental Illness. Psychiatr Q 2021; 92:1217-1229. [PMID: 33665759 PMCID: PMC8379105 DOI: 10.1007/s11126-021-09896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study was to explore psychiatrists' experience of vocational rehabilitation for patients with mental illness. The study employed a qualitative design to explore psychiatrists' experience of vocational rehabilitation. Ten psychiatrists, five women and five men, 33-62 years of age (median 40), were interviewed. All of them worked with patients at Sahlgrenska University Hospital. The interviews were analyzed using inductive thematic analysis. All participants considered vocational rehabilitation to be of great importance for patients' well-being and health. The results were characterized by two opposite experiences: frustration and agency, these were the two main themes in the analysis. All narratives embraced both experiences, but some reflected more frustration and others more agency. In order for the psychiatrist to master the assignment, there is a need for further training and supervision. The psychiatrist's role, as well as other professional roles within the team, requires clarification, and the support from rehabilitation coordinators and occupational therapists should be enhanced. There is a need for improved cooperation with external actors.
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Hultén AM, Bjerkeli P, Holmgren K. Self-reported sick leave following a brief preventive intervention on work-related stress: a randomised controlled trial in primary health care. BMJ Open 2021; 11:e041157. [PMID: 33753430 PMCID: PMC7986880 DOI: 10.1136/bmjopen-2020-041157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a brief intervention about early identification of work-related stress combined with feedback at consultation with a general practitioner (GP) on the number of self-reported sick leave days. DESIGN Randomised controlled trial. Prospective analyses of self-reported sick leave data collected between November 2015 and January 2017. SETTING Seven primary healthcare centres in western Sweden. PARTICIPANTS The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. Of these, 132 patients were allocated to intervention and 139 patients to control. INTERVENTIONS The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual. OUTCOME MEASURES The number of self-reported gross sick leave days and the number of self-reported net sick leave days, thereby also considering part-time sick leave. RESULTS At 6 months' follow-up, 220/271 (81%) participants were assessed, while at 12 months' follow-up, 241/271 (89%) participants were assessed. At 6-month follow-up, 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up, the corresponding numbers were 61/119 (51%) and 57/122 (47%), respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported gross sick leave days and the median number of self-reported net sick leave days. CONCLUSIONS The brief intervention showed no effect on the numbers of self-reported sick leave days for patients seeking care at the primary healthcare centres. Other actions and new types of interventions need to be explored to address patients' perceiving of ill health due to work-related stress. TRIAL REGISTRATION NUMBER NCT02480855.
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Affiliation(s)
- Anna-Maria Hultén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Bjerkeli
- Department for Public Health Research, University of Skövde, Skövde, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Löfvander M, Rosenblad A. Mortality among immigrant patients 20-45 years of age with chronic back pain in primary care in Sweden: A 15-year follow-up cohort study. J Back Musculoskelet Rehabil 2021; 33:801-809. [PMID: 31903979 DOI: 10.3233/bmr-181273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mortality rates among immigrant patients undergoing rehabilitation for musculoskeletal backache are unknown. OBJECTIVE To study the association between marital status, severe psychosocial strain, receiving long-term time-limited sickness allowance (TLSA) and all-cause mortality (ACM) in a cohort of immigrants aged 20-45 years with long-standing backache in Sweden. METHODS We studied 318 patients (92% foreign-born, 76% non-European) of known marital status on sick-leave for musculoskeletal backache. They were followed up for ACM until 2015. Socio-demographic data, TLSA and psychosocial strain, including major depression, severe psychosocial stressors and pessimistic thoughts, were analysed using multiple-imputation Cox regression. RESULTS Over a mean (standard deviation) follow-up time of 15 (5.0) years, 11 (3.5%) participants died. At baseline, 34% were unmarried, 19% were receiving TLSA, and 71% had ⩾ 1 psychosocial strain component (38% depression; 47% severe stressors; 35% pessimistic thoughts). After concomitant risk factors were adjusted for, being unmarried and receiving TLSA were associated with higher mortality by factors of 6.2 (p= 0.005) and 5.8 (p= 0.006), respectively. Psychosocial strain was only significantly associated with higher mortality in the unadjusted analyses. CONCLUSIONS Being unmarried and receiving TLSA were associated with significantly higher ACM in this highly marginalized group of immigrant patients.
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Affiliation(s)
- Monica Löfvander
- Center for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.,Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Unit, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Center for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
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Hultén AM, Dahlin-Ivanoff S, Holmgren K. Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation. BMC FAMILY PRACTICE 2020; 21:187. [PMID: 32917138 PMCID: PMC7488670 DOI: 10.1186/s12875-020-01258-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/31/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave. METHODS A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger. RESULTS Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress. CONCLUSIONS The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated. TRIAL REGISTRATION ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.
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Affiliation(s)
- Anna-Maria Hultén
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Synneve Dahlin-Ivanoff
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bengtsson Boström K, Starzmann K, Östberg AL. Primary care physicians' concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden. Scand J Prim Health Care 2020; 38:146-155. [PMID: 32314635 PMCID: PMC8570729 DOI: 10.1080/02813432.2020.1753341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: 'The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients'. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians' coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians' work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTSIn 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians' work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.
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Affiliation(s)
- Kristina Bengtsson Boström
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University og Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
| | - Karin Starzmann
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University og Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
| | - Anna-Lena Östberg
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Nordling P, Priebe G, Björkelund C, Hensing G. Assessing work capacity - reviewing the what and how of physicians' clinical practice. BMC FAMILY PRACTICE 2020; 21:72. [PMID: 32340611 PMCID: PMC7187489 DOI: 10.1186/s12875-020-01134-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Abstract
Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.
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Affiliation(s)
- P Nordling
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden. .,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
| | - G Priebe
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
| | - C Björkelund
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
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Lännerström L, Holmström IK, Wallman T. The effect of a short educational intervention in social insurance medicine: A randomized controlled trial. Nurs Open 2020; 7:523-529. [PMID: 32089848 PMCID: PMC7024614 DOI: 10.1002/nop2.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022] Open
Abstract
Aim To evaluate the effect of an educational intervention in social insurance medicine with Registered Nurses. Design Randomized controlled trial. Methods The trial was performed in 20 primary healthcare centres in Central Sweden. The centres were randomly assigned as intervention or control. All Registered Nurses working with telephone nursing at the centres were invited (N = 114); out of these 100 agreed to participate and responded to a questionnaire at the beginning and end of the trial. Fourteen questions in the questionnaire dealt with professional background and were used as exposure variables and were analysed using nominal logistic regression. Results Registered Nurses in the centres randomly assigned for the intervention experienced handling sick leave questions as less problematic after the intervention than those in the control group. This indicated that the intervention was associated with a positive effect. However, due to the rather small study population, the effect was inconclusive.
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Affiliation(s)
- Linda Lännerström
- Department of Public Health and Caring SciencesFamily Medicine and Preventive Medicine SectionUppsala UniversityUppsalaSweden
- Centre for Clinical Research SörmlandUppsala UniversityEskilstunaSweden
| | - Inger K. Holmström
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
- Department of Public Health and Caring SciencesHealth Services Research SectionUppsala UniversityUppsalaSweden
| | - Thorne Wallman
- Department of Public Health and Caring SciencesFamily Medicine and Preventive Medicine SectionUppsala UniversityUppsalaSweden
- Centre for Clinical Research SörmlandUppsala UniversityEskilstunaSweden
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12
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Sturesson M, Bylund SH, Edlund C, Falkdal AH, Bernspång B. Collaboration in work ability assessment for sick-listed persons in primary healthcare. Work 2020; 65:409-420. [PMID: 32007984 DOI: 10.3233/wor-203093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work. OBJECTIVE Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave. METHODS Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention's implementation. RESULTS No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient. CONCLUSION Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.
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Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Sonya Hörnqvist Bylund
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
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Shutzberg M. Unsanctioned techniques for having sickness certificates accepted: a qualitative exploration and description of the strategies used by Swedish general practitioners. Scand J Prim Health Care 2019; 37:10-17. [PMID: 30689481 PMCID: PMC6454410 DOI: 10.1080/02813432.2019.1569426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore informal and unsanctioned techniques general practitioners (GPs) employ as a means to increase the likelihood of sickness certificate approval, following the Swedish Social Insurance Agency's (SSIA's) consolidation of the gatekeeping role in sickness benefit evaluation. DESIGN Qualitative semi-structured interviews with 20 GPs working in Swedish primary care. A thematic analysis of the transcribed material was carried out to map different techniques employed by the practitioners. RESULTS Eight techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. The identified techniques were most commonly adopted when the patient's case was perceived to be at high risk for rejection by the SSIA (such as psychiatric illnesses, chronic pain etc.). CONCLUSIONS The findings imply that the informal and unsanctioned techniques are complex and ambiguous. They are used intentionally and covertly. The study also suggests that, while the consolidation of SSIA's gatekeeping role may have resolved some sickness absence issues, a consequence may be that GPs develop unsanctioned techniques to ensure compliance.
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Affiliation(s)
- Mani Shutzberg
- Centre for Studies in Practical Knowledge, Södertörn University, Stockholm, Sweden
- CONTACT Mani Shutzberg Centre for Studies in Practical Knowledge, Södertörn University, Stockholm, Sweden
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Secular trends in sickness absence among Swedish patients with ankylosing spondylitis and psoriatic arthritis. Rheumatol Int 2017; 38:275-282. [PMID: 28879599 PMCID: PMC5773654 DOI: 10.1007/s00296-017-3809-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
The aim was to investigate whether secular trends in sickness absence (SA) were present in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) receiving their diagnosis between 2002 and 2011. A repeated cross-sectional study design was used. Patients were identified in the Skåne Healthcare Register (SHR). A washout period of 18 months was applied. The general population seeking health care was used as a reference cohort. SA data from 2003 to 2012 were obtained from the Swedish Social Insurance Agency and converted into net days of SA per year. Within diagnosis and sex, the average number of net days of SA during the calendar year following diagnosis was calculated and plotted against calendar year together with the corresponding SA of the age-standardized reference population. Linear regression on aggregated data, within diagnosis and sex, was applied to formally investigate differences in secular trends among patients and referents. There were 3173 patients and 992,502 referents. Among men diagnosed with AS, the average amount of SA declined by 8.1 net days per year in patients as compared with 2.4 in the referents (p = 0.01). Among PsA patients, the average amount of SA declined by 11.7 net days per year in women as compared with 2.7 in the referents (p < 0.001) and by 7.6 net days per year in men as compared with 1.9 in the referents (p < 0.001). Secular trends of declining SA were present among AS and PsA patients. Trends were also present among the referents, although not at all of the same magnitude.
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15
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Lännerström L, von Celsing AS, Holmström IK, Wallman T. Registered nurses' work with sick leave questions by telephone in primary health care. J Clin Nurs 2016; 26:641-647. [PMID: 27626185 DOI: 10.1111/jocn.13580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe registered nurses' work with sick leave questions by telephone. BACKGROUND In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies. DESIGN A descriptive cross-sectional study. METHODS A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis. RESULTS Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education. CONCLUSION Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine. RELEVANCE TO CLINICAL PRACTICE There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.
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Affiliation(s)
- Linda Lännerström
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna-Sophia von Celsing
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Health Services Research Section, Uppsala University, Uppsala, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Brijnath B, Mazza D, Kosny A, Bunzli S, Singh N, Ruseckaite R, Collie A. Is clinician refusal to treat an emerging problem in injury compensation systems? BMJ Open 2016; 6:e009423. [PMID: 26792215 PMCID: PMC4735202 DOI: 10.1136/bmjopen-2015-009423] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. DESIGN Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. SETTING Compensable injury management in general practice in Melbourne, Australia. PARTICIPANTS 25 GPs who were treating, or had treated a patient with compensable injury. RESULTS The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. CONCLUSIONS In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries.
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Affiliation(s)
- Bianca Brijnath
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | | | - Samantha Bunzli
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Victoria, Australia
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Sturesson M, Bylund SH, Edlund C, Falkdal AH, Bernspång B. Quality in sickness certificates in a Swedish social security system perspective. Scand J Public Health 2015; 43:841-7. [PMID: 26229074 DOI: 10.1177/1403494815597163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
Abstract
AIM In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate. METHODS An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. RESULTS Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found. CONCLUSION Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.
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Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
| | | | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
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