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Primary Healthcare Professionals' Experiences of the Sick Leave Process: A Focus Group Study in Sweden
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-1588-135X
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
2013 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 3, 450-461 p.Article in journal (Refereed) Published
Abstract [en]

Purpose The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in A-stergotland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed.

Place, publisher, year, edition, pages
SPRINGER/PLENUM PUBLISHERS , 2013. Vol. 23, no 3, 450-461 p.
Keyword [en]
Sick leave, Work ability, Rehabilitation, Return to work, Physicians, Healthcare professionals, Sickness certificates, Primary healthcare, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-89836DOI: 10.1007/s10926-013-9418-0ISI: 000322880900015PubMedID: 23345119OAI: oai:DiVA.org:liu-89836DiVA: diva2:609918
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2017-12-06Bibliographically approved
In thesis
1. The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
Open this publication in new window or tab >>The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Decisions on entitlement to sickness benefits and return to work interventions have substantial impact on individuals’ lives and on society. In most Western European countries, such decisions are based on sickness certificates, which should provide information on how a disease or injury reduces the individual’s work ability. These are challenging and complex assessments. In 2008, guidelines for the management of sick leave were implemented in Sweden, emphasizing early assessments of work ability and return to work, and increasing the quality demands of sickness certificates by underscoring descriptions of activity limitations related to work. The overall aim of this thesis was to gain a deeper knowledge of the sick leave process with special emphasis on the content of sickness certificates and primary health care (PHC) professionals’ experiences with the process. Specific aims were to compare the quality of sickness certificates regarding descriptions of functioning by the use of WHO’s International Classification of Functioning, disability, and health (ICF), as well as the prescribed interventions before versus after implementation of the Swedish sick leave guidelines.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

An overall conclusion drawn from this thesis is that patient functioning and needs might not be adequately communicated in the sick leave process. Despite the implementation of sick leave guidelines, this information is limited in sickness certificates and the collaboration is poor among the involved stakeholders, i.e., health care, the social insurance office, the employer and the OHS. The basis for decisions on entitlement to sickness benefits could be improved by including a description of the patients’ activity limitations or participation restrictions related to work demands. One way to enhance the decision basis might be to use the available team competencies at the PHC.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1354
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89838 (URN)978-91-7519-689-3 (ISBN)
Public defence
2013-04-05, Aulan, Hälsans Hus ingång 16, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2013-03-08Bibliographically approved

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Nilsing, EmmaSöderberg, ElsyBerterö, CarinaÖberg, Birgitta

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