| 1. |
- Berglund, Erik, et al.
(författare)
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Coordination and Perceived Support for Return to Work : A Cross-Sectional Study among Patients in Swedish Healthcare
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49-11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient's perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.
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| 2. |
- Berglund, Erik, et al.
(författare)
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Physicians' experience of and collaboration with return-to-work coordinators in healthcare : a cross-sectional study in Sweden
- 2023
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165.
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Tidskriftsartikel (refereegranskat)abstract
- PurposeReturn-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 methodsOf 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.ResultsAmong 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.ConclusionsPhysicians 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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| 3. |
- Engblom, Monika
(författare)
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Sickness certification when experienced as problematic by physicians
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Physicians play an essential role in the sickness absence process, and many of them experience related tasks as problematic. The overall aim of this thesis was to improve the understanding of sickness certification experienced as problematic by physicians in general practice and occupational health services, and to gain more knowledge about the frequency and severity of those problems. Materials and methods: Four studies were conducted, two of which were based on written cases reports, one on discussions of those reports, and one on questionnaire data. Courses intended to improve sickness certification practices for physicians in general practice and occupational health services were held in different parts of Sweden. Before taking part in such a course, the physicians were to send in a case report describing one of their own problematic sickness certification cases. During the courses, these cases were considered in group discussions. In the first study, dilemmas experienced by the physicians regarding their problematic cases were identified. The research material that was analysed consisted of some 100 documented names of dilemmas obtained from five courses, and the analytical method used was a descriptive one-step categorisation. In the second study, the main characteristics of 195 written case reports from nine courses were discerned by analysis using a stepwise descriptive categorisation and quantification. In the third study, 44 case reports were analysed with a narrative approach with elements from both thematic and structural analysis. In the fourth study, the material consisted of answers to a questionnaire that had been sent to all physicians in Sweden. The analyses included responses from 2,516 specialists in general practice regarding the frequency and severity of problems in sickness certification, and the frequency of approving unnecessarily long sick-leave periods for different reasons. Results: Eight categories of dilemmas experienced by general practitioners were identified. Examples of these were “not the doctors’ pigeon” (when the patients’ problem was perceived as not being medical in nature), “diagnosis as disguise” (when there was a discrepancy between how the patient described the problems and what the physician apprehended), and “harmed by sick listing” (when the physician perceived that the main problem was the iatrogenic adverse effects of sick leave per se). In the analyses of the written case reports about problematic sickness certification, information on the following was often provided: age and sex, family situation, occupation, stressful life events, and medical investigations and treatments. Two thirds of the patients had been on sick leave for more than a year. It was found that the most common type of cases concerned women, who were employed in non-qualified nursing occupations and were on sick leave due to psychiatric diagnoses. Furthermore, the most common measures taken by the physician were referrals to a psychotherapist and/or physiotherapist, and prescribing antidepressants. In their written case reports, physicians described clearly different ways to relate to the problems they faced, and five “types of message” were identified. A common feature of the case reports was a striving for neutrality, and that the patients’ stories tended to be interpreted within a traditional biomedical frame. The physicians’ personal and emotional involvement and their relations with the patient were visible to varying extents. Overall, the responses were about having problems as such, rather than the specific features of the problems. According to the national survey about frequency and severity of problems, general practitioners considered assessments of work capacity to be very or fairly problematic. Other problems reported in this context were related to the following: handling situations in which the physician and the patient had different opinions about the need for sick leave, and managing the dual roles as both treating physician and medical expert when writing certificates to be used by the social insurance office. At least once a month, a majority of the physicians issued sickness certificates for longer periods than they deemed necessary, often due to waiting times in health care and in other organisations. Younger and male specialists more often reported doing this in order to avoid conflicts with the patients. Conclusions: The tasks involved in sickness certification challenge the physicians’ professionalism in certain ways, and several related problems are reported to be both frequent and severe. Cases perceived as problematic have several characteristics in common. Some of the problems were more closely related to consultations and typical situations in which the physician had difficulties in acting in accordance with his or her sense of what was the right thing to do, primarily due to conflicting demands or loyalties.
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| 4. |
- Engblom, Monika, et al.
(författare)
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When physicians get stuck in sick-listing consultations : A qualitative study of categories of sick-listing dilemmas
- 2010
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 35:2, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice. Design and subjects: Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis. Results: Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing - reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se). Implications: The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.
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| 5. |
- Svärd, Veronica, et al.
(författare)
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Coordinators in the return-to-work process : Mapping their work models
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:8
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Tidskriftsartikel (refereegranskat)abstract
- PurposeIn recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden.MethodsA questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models.ResultsThree work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry.ConclusionThe work models correspond differently to the coordinator’s assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.
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