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Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden

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Abstract

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 Östergötland 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.

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References

  1. Gimeno D, Benavides FG, Benach J, Amick BC III. Distribution of sickness absence in the European Union countries. Occup Environ Med. 2004;61(10):867–9.

    Article  PubMed  CAS  Google Scholar 

  2. Alexanderson K, Norlund A, Swedish Council on Technology Assessment in Health Care (SBU). Chapter 1. Aim, background, key concepts, regulations, and current statistics. Scand J Public Health Suppl. 2004;63:12–30.

    Article  PubMed  Google Scholar 

  3. Wahlstrom R, Alexanderson K, Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians’ sick-listing practices. Scand J Public Health Suppl. 2004;63:222–55.

    Article  PubMed  Google Scholar 

  4. Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care. 2010;28(2):67–75.

    Article  PubMed  Google Scholar 

  5. Timpka T, Hensing G, Alexanderson K. Dilemmas in sickness certification among Swedish physicians. Eur J Public Health. 1995;5:215–9.

    Article  Google Scholar 

  6. Lofgren A, Hagberg J, Arrelov B, Ponzer S, Alexanderson K. Frequency and nature of problems associated with sickness certification tasks: a cross-sectional questionnaire study of 5455 physicians. Scand J Prim Health Care. 2007;25(3):178–85.

    Article  PubMed  Google Scholar 

  7. Swartling MS, Alexanderson KA, Wahlstrom RA. Barriers to good sickness certification—an interview study with Swedish general practitioners. Scand J Public Health. 2008;36(4):408–14.

    Article  PubMed  Google Scholar 

  8. von Knorring M, Sundberg L, Lofgren A, Alexanderson K. Problems in sickness certification of patients: a qualitative study on views of 26 physicians in Sweden. Scand J Prim Health Care. 2008;26(1):22–8.

    Article  Google Scholar 

  9. Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R. Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ. 2004;328(7431):88.

    Article  PubMed  Google Scholar 

  10. Wynne-Jones G, Mallen C, Main C, Dunn K. Sickness certification and the GP: what really happens in practice? Fam Pract. 2009;27(3):344–50.

    Article  PubMed  Google Scholar 

  11. Swartling MS, Hagberg J, Alexanderson K, Wahlstrom RA. Sick-listing as a psychosocial work problem: a survey of 3997 Swedish physicians. J Occup Rehabil. 2007;17(3):398–408.

    Article  PubMed  Google Scholar 

  12. Ljungquist T, Arrelov B, Lindholm C, Wilteus AL, Nilsson GH, Alexanderson K. Physicians who experience sickness certification as a work environmental problem: where do they work and what specific problems do they have? A nationwide survey in Sweden. BMJ Open. 2012;2(2):e000704. doi:10.1136/bmjopen-2011-000704.

    Article  PubMed  Google Scholar 

  13. Larsson C, Sydsjo A, Alexanderson K, Sydsjo G. Obstetricians’ attitudes and opinions on sickness absence and benefits during pregnancy. Acta Obstet Gynecol Scand. 2006;85(2):165–70.

    Article  PubMed  Google Scholar 

  14. Swartling M, Peterson S, Wahlstrom R. Views on sick-listing practice among Swedish General Practitioners—a phenomenographic study. BMC Fam Pract. 2007;8:44.

    Article  PubMed  Google Scholar 

  15. Osteras N, Gulbrandsen P, Benth JS, Hofoss D, Brage S. Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial. BMC Fam Pract. 2009;10(1):31.

    Article  PubMed  Google Scholar 

  16. Nilsen S, Werner EL, Maeland S, Eriksen HR, Magnussen LH. Considerations made by the general practitioner when dealing with sick-listing of patients suffering from subjective and composite health complaints. Scand J Prim Health Care. 2011;29(1):7–12.

    PubMed  Google Scholar 

  17. Pransky G, Katz JN, Benjamin K, Himmelstein J. Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners. Disabil Rehabil. 2002;24(16):867–74.

    Article  PubMed  CAS  Google Scholar 

  18. Stigmar K, Grahn B, Ekdahl C. Work ability—experiences and perceptions among physicians. Disabil Rehabil. 2010;32(21):1780–9.

    Article  PubMed  Google Scholar 

  19. Lofvander M, Engstrom A. An observer-participant study in primary care of assessments of inability to work in immigrant patients with ongoing sick leave. Scand J Prim Health Care. 2003;21(4):199–204.

    Article  PubMed  Google Scholar 

  20. Roope R, Parker G, Turner S. General practitioners’ use of sickness certificates. Occup Med (Lond). 2009;59(8):580–5.

    Article  Google Scholar 

  21. Edlund C, Dahlgren L. The physician’s role in the vocational rehabilitation process. Disabil Rehabil. 2002;24(14):727–33.

    Article  PubMed  Google Scholar 

  22. Loisel P, Durand MJ, Berthelette D, Vezina N, Baril R, Gagnon D, et al. Disability prevention new paradigm for the management of occupational back pain. Dis Manag Health Outcomes. 2001;9(7):351–60.

    Article  Google Scholar 

  23. Holdsworth LK, Webster VS, McFadyen AK. Physiotherapists’ and general practitioners’ views of self-referral and physiotherapy scope of practice: results from a national trial. Physiotherapy. 2008;94(3):236–43.

    Article  Google Scholar 

  24. Stigmar K, Ekdahl C, Grahn B. Work ability: concept and assessment from a physiotherapeutic perspective. An interview study. Physiother Theory Pract. 2012;28(5):344–54.

    Article  PubMed  CAS  Google Scholar 

  25. Sturesson M, Edlund C, Fjellman-Wiklund A, Falkdal AH, Bernspang B. Work ability as obscure, complex and unique: views of Swedish occupational therapists and physicians. Work. 2012;. doi:10.3233/WOR-2012-1416.

    Google Scholar 

  26. Stahl C, Svensson T, Petersson G, Ekberg K. The work ability divide: holistic and reductionistic approaches in Swedish interdisciplinary rehabilitation teams. J Occup Rehabil. 2009;19(3):264–73.

    Article  PubMed  Google Scholar 

  27. Socialstyrelsen. [National Board of Health and Welfare]. Försäkringsmedicinskt beslutsstöd—vägledning för sjukskrivning. [Sick leave guidelines]. Stockholm; 2007 (in Swedish).

  28. Black C. Working for a healthier tomorrow. Norwich: TSO; 2008.

    Google Scholar 

  29. OECD. Sickness, disability and work: breaking the barriers. A synthesis of findings across OECD countries. OECD Publishing; 2010.

  30. Skaner Y, Nilsson GH, Arrelov B, Lindholm C, Hinas E, Wilteus AL, et al. Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden. BMJ Open. 2011;1(2):e000303.

    Article  PubMed  Google Scholar 

  31. Bremander AB, Hubertsson J, Petersson IF, Grahn B. Education and benchmarking among physicians may facilitate sick-listing practice. J Occup Rehabil. 2012;22(1):78–87.

    Article  PubMed  CAS  Google Scholar 

  32. Gabbay M, Taylor L, Sheppard L, Hillage J, Bambra C, Ford F, et al. NICE guidance on long-term sickness and incapacity. Br J Gen Pract. 2011;61(584):e118–24.

    Article  PubMed  Google Scholar 

  33. Krueger RA, Casey MA, editors. Focus groups: a practical guide for applied research. Thousands Oaks: SAGE; 2009.

    Google Scholar 

  34. Morgan DL, editor. Focus groups as qualitative research methods series. Thousand Oaks: SAGE; 1997.

    Google Scholar 

  35. Östergötland Landsting. [Östergötland County]. Årsredovisning; 2011. [Annual report 2011]. Available from http://www.lio.se. Cited 14 Sept 2012.

  36. Patton MQ. Qualitative research & evaluation methods. 3rd ed. Thousands Oaks: SAGE; 2002.

    Google Scholar 

  37. Coole C, Watson PJ, Drummond A. Work problems due to low back pain: what do GPs do? A questionnaire survey. Fam Pract. 2010;27(1):31–7.

    Article  PubMed  Google Scholar 

  38. Cohen DA, Aylward M, Rollnick S. Inside the fitness for work consultation: a qualitative study. Occup Med (Lond). 2009;59(5):347–52.

    Article  CAS  Google Scholar 

  39. Dekkers-Sanchez PM, Hoving JL, Sluiter JK, Frings-Dresen MH. Factors associated with long-term sick leave in sick-listed employees: a systematic review. Occup Environ Med. 2008;65(3):153–7.

    Article  PubMed  CAS  Google Scholar 

  40. Cornelius LR, van der Klink JJ, Groothoff JW, Brouwer S. Prognostic factors of long term disability due to mental disorders: a systematic review. J Occup Rehabil. 2011;21(2):259–74.

    Article  PubMed  CAS  Google Scholar 

  41. Vlasveld MC, van der Feltz-Cornelis CM, Bultmann U, Beekman AT, van Mechelen W, Hoedeman R, et al. Predicting return to work in workers with all-cause sickness absence greater than 4 weeks: a prospective cohort study. J Occup Rehabil. 2012;22(1):118–26.

    Article  PubMed  CAS  Google Scholar 

  42. Alavinia SM, van den Berg TI, van Duivenbooden C, Elders LA, Burdorf A. Impact of work-related factors, lifestyle, and work ability on sickness absence among Dutch construction workers. Scand J Work Environ Health. 2009;35(5):325–33.

    Article  PubMed  Google Scholar 

  43. Kosny A, Franche RL, Pole J, Krause N, Cote P, Mustard C. Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury. J Occup Rehabil. 2006;16(1):27–39.

    Article  PubMed  Google Scholar 

  44. Johansen K, Andersen JS, Mikkelsen S, Lynge E. Decision making and co-operation between stakeholders within the process of sick leave. A case study in a Danish municipality. J Interprof Care. 2011;25(1):59–65.

    Article  PubMed  Google Scholar 

  45. Coar L, Sim J. Interviewing one’s peers: methodological issues in a study of health professionals. Scand J Prim Health Care. 2006;24(4):251–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank all the healthcare professionals who agreed to be interviewed.

Conflict of interest

The authors declare that they have no competing interests. The study was funded by the County Council in Östergötland, Sweden.

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Correspondence to Emma Nilsing.

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Nilsing, E., Söderberg, E., Berterö, C. et al. Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden. J Occup Rehabil 23, 450–461 (2013). https://doi.org/10.1007/s10926-013-9418-0

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