Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Primärvårdens arbete med sjukskrivna – patientmötet, bedömningar och samverkan
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
2015 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The ability to work can be reduced if a person has health problems which may lead to periods of sick leave. In Sweden sickness certification is issued by physicians. Many general practitioners (GPs) find sickness certification to be problematic. Some studies indicate that collaboration with other health care professions could be beneficial. The aim of the thesis was to provide knowledge on how the work with the sick leave process in primary health care can be improved and how occupational therapists’ (OT) assessment could be used prior to the decision on sick leave and rehabilitation. Initially seven focus groups were held, four with OTs and three with physicians. The discussions in the focus gropes were analysed by qualitative content analysis. An intervention project was initiated, where four health care centres in northern Sweden tested a working approach where sick listed patients were offered a supplementary assessment of activity and work-related problems by an OT. Data on sick leave, sickness certificates and patient questionnaires were collected from intervention health care centres (IHCC) and other health care centres (OHCC). Interviews were conducted with patients, GPs and OTs. The quality of the information in the collected sickness certificates was evaluated. Average values of sick leave were compared between the IHCCs and the OHCCs in the county. The interviews with sick listed patients were analysed by qualitative content analysis. In order to analyse the implementation of the intervention the Consolidated Framework for Implementation Research, CFIR, was used. An overall theme and four categories emerged from the focus groups. The theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirmed the complex structure of work ability: the person, the context of life, the work, and the society. No significant differences between IHCCs and OHCCs in data on sick leave or the mandatory information in the certificates were found. Thirty-four percent of the collected sickness certificates did not contain all requested information. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was significantly more often prescribed for male patients than for female. Two themes revealed that highlight important areas for persons on sick leave in their healthcare encounters. The theme ‘Trust in the relationship’ contains categories describing the patients’ feelings of participation, being believed, confirmed, and listened to. The second theme ‘Structure and balance’ contains the participants’ views on important factors that could facilitate the return-to-work process such as a structured plan and support to balance activity. The analysis with CFIR clarified that coaching and education for all the users are crucial to get fidelity when new interventions are tested as well as involvement by the clinical department manager. The work with sick leave issues in primary health care can be improved by developing cooperation with several different professionals. To achieve an increased cooperation new working approaches are required. These working approaches must be anchored in management and requires an applied implementation strategy. More focus on the quality of encounters with healthcare professionals can also improve the sick leave process in primary health care centres. The healthcare encounters must build on a mutual trust and sick-listed persons’ return to work can be facilitated by providing a clear structure in the process and support in occupational balance. For issuing sickness certification further education about the descriptions of functioning and the tasks included in the patient’s work is needed. A better gender awareness in the health care encounters is also necessary.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2015. , 96 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1744
Keyword [en]
Primary health care, Sickness certification, Work ability, Health care encounters, Occupational Therapy, Return to work
National Category
Occupational Therapy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-109757ISBN: 978-91-7601-332-8 (print)OAI: oai:DiVA.org:umu-109757DiVA: diva2:858970
Public defence
2015-10-29, Aulan Vårdvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-08 Created: 2015-10-05 Last updated: 2015-10-07Bibliographically approved
List of papers
1. Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians
Open this publication in new window or tab >>Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians
Show others...
2013 (English)In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 45, no 1, 117-128 p.Article in journal (Refereed) Published
Abstract [en]

The concept of work ability is not clearly defined although it has a central place in vocational rehabilitation. Several health professions are involved in assessing work ability, physicians and occupational therapists are two of these. OBJECTIVE: The purpose of this study was to explore occupational therapist and physician views about work ability and experiences in assessing work ability. PARTICIPANTS: Fourteen physicians and 23 occupational therapists participated in seven focus group discussions that were audio taped and transcribed verbatim. METHODS: Qualitative content analysis was used. Each author performed an individual preliminary analysis. These analyses were later discussed and refined in the research team and a workshop. The final categorization resulted in one theme, four categories and 13 sub-categories. RESULTS: The overall theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirm the complex structure of work ability: the person, the context of life, the work, and the society. Physicians expressed greater difficulty in assessing work ability than occupational therapists did, because they have fewer instruments to access this concept. CONCLUSIONS: Assessment of work ability requires team cooperation with several different professionals. Cooperation could increase accuracy in issuing sickness certification and strengthens the ability of identifying individual requirements for rehabilitation.

Place, publisher, year, edition, pages
AMSTERDAM, NETHERLANDS: IOS PRESS, 2013
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-73590 (URN)10.3233/WOR-2012-1416 (DOI)000318769600013 ()
Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2017-12-06Bibliographically approved
2. Collaboration in work ability assessment for sick-listed persons in primary health care
Open this publication in new window or tab >>Collaboration in work ability assessment for sick-listed persons in primary health care
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-109753 (URN)
Available from: 2015-10-05 Created: 2015-10-05 Last updated: 2015-10-07
3. Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences.
Open this publication in new window or tab >>Healthcare encounters and return to work: a qualitative study on sick-listed patients' experiences.
2014 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 4, 464-475 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sickness absence is a complex phenomenon affected by aspects other than disease. One important factor that can affect sick leave is the individual's experience of healthcare encounters. It is therefore essential to consider the quality of the encounter with health professionals and its impact on the patient's rehabilitation and return to work.

AIM: The aim was to explore how sick-listed patients in Sweden perceive their contact with healthcare professionals in primary healthcare and to analyse what they view as crucial components for returning to work.

METHODS: A qualitative approach was used. Data were collected by semi-structured telephonic interviews with patients who were or had been on sick leave. The transcribed interview text was analysed according to qualitative content analysis.

FINDINGS: The analysis revealed two themes that highlight important areas for persons on sick leave in their healthcare encounters. The theme 'Trust in the relationship' contains categories describing the patients' feelings of participation, and of being believed, confirmed, and listened to, and also dedication on the part of healthcare providers. Healthcare encounters that were characterised by professionalism, knowledge, continuity, and a holistic approach seemed to create trust. The theme 'Structure and balance' contains the participants' views on important factors that could support the return-to-work process. All participants stated the importance of follow-up and a plan for rehabilitation. Sick leave itself can make a person passive, and participants in this study asked for support to balance activity, exercise, and work demands, which could facilitate their return to work.

CONCLUSION: Healthcare professionals can facilitate sick-listed persons' rehabilitation back to work by providing a clear structure in the process and support in occupational balance. The healthcare encounters must build on a mutual trust.

Place, publisher, year, edition, pages
Cambridge University Press, 2014
National Category
Other Health Sciences
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-96990 (URN)10.1017/S1463423614000255 (DOI)25098326 (PubMedID)
Available from: 2015-02-02 Created: 2014-12-08 Last updated: 2017-12-05Bibliographically approved
4. Quality in sickness certificates in a Swedish social security system perspective
Open this publication in new window or tab >>Quality in sickness certificates in a Swedish social security system perspective
Show others...
2015 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, 841-847 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Sick leave, primary health care, gender, International Classification of Functioning, Disability and Health, insurance medicine
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-108225 (URN)10.1177/1403494815597163 (DOI)000364636600009 ()26229074 (PubMedID)
Available from: 2015-09-08 Created: 2015-09-07 Last updated: 2017-12-04Bibliographically approved

Open Access in DiVA

fulltext(1193 kB)624 downloads
File information
File name FULLTEXT01.pdfFile size 1193 kBChecksum SHA-512
cf29b4053e21e480d324901281bded885bff35bef7dc99709be69aab98429c2073d6d52b2e3718e840a3f2699037302e30672b8b9adab55c0ad718284ba35de9
Type fulltextMimetype application/pdf
spikblad(104 kB)13 downloads
File information
File name SPIKBLAD01.pdfFile size 104 kBChecksum SHA-512
14e425f030cbe5e00f57225f82864fda41851de9d0ff008ac713a9dcdfad50f80c0132e9e9b1e428c83743eb0a27d973c3224b10dbaa6a8effff35882010b225
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Sturesson, Marine
By organisation
Occupational Therapy
Occupational TherapyHealth Care Service and Management, Health Policy and Services and Health Economy

Search outside of DiVA

GoogleGoogle Scholar
Total: 624 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1014 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf