1
|
Honkonen N, Lamminpää A, Liira J. Work ability meetings - Challenges and Resolutions, a survey to Finnish occupational physicians. Work 2024:WOR230331. [PMID: 38995747 DOI: 10.3233/wor-230331] [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: 07/14/2024] Open
Abstract
BACKGROUND Work ability meetings (WAM) are an essential and common tool of disability management in occupational health services in Finland. Meetings are held between an employee, a supervisor, and an occupational physician (OP). The aim is mainly to support work ability. OBJECTIVES To describe challenges and resolutions in the meetings as described by OPs. METHODS An internet survey was emailed to the members (n = 1304) of the Finnish Society of Occupational Health Physicians in August 2014. We asked physicians to describe those WAMs they had attended, especially challenges and resolutions concerning WAM. RESULTS A total of 302 (23%) OPs responded to the survey. Most severe of the challenges were personal conflicts and a lack of confidence between the parties at the workplace. Also, the participants' views may differ about the purpose and goal of the meeting. The respondents noted that the employer might be unable to organize modified work for disabled employees. As a resolution, OPs need to prepare well and maintain their professional and neutral role in WAMs in all cases. OPs also mentioned the need for training in insurance medicine and rehabilitation as well as skills as a mediator. CONCLUSIONS WAM is a potential tool for return to work and disability management in collaboration between employees, employers, and occupational health when all the participants reach a common goal and become aware of their role in the process. OPs need to recognize possible conflicting interests and contact each party before WAM. Keeping confidentiality in WAMs is a crucial matter.
Collapse
Affiliation(s)
| | - Anne Lamminpää
- Faculty on Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Liira
- Faculty of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
2
|
Reho T, Atkins S, Korhonen M, Siukola A, Viljamaa M, Sumanen M, Uitti J, Sauni R. Occupational health patients' parallel use of primary- and secondary-care services and linkage to work disability: A follow-up study in Finland. Scand J Public Health 2024; 52:128-135. [PMID: 36324196 PMCID: PMC10913288 DOI: 10.1177/14034948221130438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/15/2022] [Accepted: 09/13/2022] [Indexed: 02/17/2024]
Abstract
AIMS This study aimed to investigate occupational health (OH) primary-care patients' use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). METHODS Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014-2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. RESULTS Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. CONCLUSIONS OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits - either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support.
Collapse
Affiliation(s)
- Tiia Reho
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Pihlajalinna Työterveys, Finland
| | - Salla Atkins
- Department of Global Public Health, Karolinska Institutet, Sweden
- New Social Research and Faculty of Social Sciences, Tampere University, Finland
| | - Mikko Korhonen
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Anna Siukola
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | | | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Clinic of Occupational Medicine, Tampere University Hospital, Finland
| | - Riitta Sauni
- Faculty of Medicine and Health Technology, Tampere University, Finland
| |
Collapse
|
3
|
Aiming at inclusive workplaces: A bibliometric and interpretive review at the crossroads of disability management and human resource management. JOURNAL OF MANAGEMENT & ORGANIZATION 2023. [DOI: 10.1017/jmo.2023.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Abstract
Inclusive workplaces rely on the joint optimization of disability management and human resource management. However, disability management has been predominantly investigated as an independent issue, overlooking its interplay with human resource management. The article delivers a bibliometric and interpretive review of the scholarly debate falling at the crossroad of disability management and human resource management, mapping the state of the art of this study domain. Departing from a knowledge core of 91 papers, 6 research streams were identified through bibliographic coupling. They account for the evolution of disability management from a fix-it initiative aimed at fostering return to work of people with disability towards a holistic management approach targeted at inclusiveness. Aligning the hard and the soft sides of disability management and embedding it in the organizational culture are crucial to enact inclusive workplaces and make organizations able to engage people with disability at work.
Collapse
|
4
|
Reho TTM, Atkins S, Korhonen M, Siukola A, Sumanen M, Viljamaa M, Uitti J, Sauni R. Parallel use of primary and secondary healthcare by frequent attenders in occupational health and their work disability: a longitudinal study in Finland. BMJ Open 2022; 12:e052740. [PMID: 35414544 PMCID: PMC9006804 DOI: 10.1136/bmjopen-2021-052740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate occupational health frequent attenders' (FAs) use of other healthcare sector services and whether parallel use affects their likelihood to receive a disability pension. DESIGN Longitudinal study combining routine medical record data with register data. SETTING Primary care in Finland is provided through three parallel healthcare sectors, all available to the working population. Additionally, patients can be referred to secondary care. This study combines medical record data from a nationwide occupational healthcare provider, with healthcare attendance data from private care and from public primary and secondary care attendance, sociodemographic data and disability pension decisions. PARTICIPANTS Patients between 18 and 68 years of age who used occupational health primary care at least once during the study years 2014-2016 were included. The total study population was 59 650 patients. They were divided into three groups (occasional and persistent FAs and non-FAs) for analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was FAs parallel use of private care and public primary and secondary care. The secondary outcome was work disability pension granted to FAs who used several healthcare sectors. RESULTS Both FA groups were more likely to use other healthcare service sectors more than non-FAs did. Persistent FAs were likely to use public secondary care services in particular (OR 4.31 95% CI 3.46 to 5.36). FAs using all healthcare sectors were also more likely to receive a disability pension than those FAs using only occupational health services (OR 4.53 (95% CI 1.54 to 13.34). This association was strengthened by attendance in public secondary care. CONCLUSIONS FAs using several healthcare sectors in parallel have an increased likelihood to receive a disability pension. There is need for care coordination to ensure adequate measures for work ability support.
Collapse
Affiliation(s)
- Tiia T M Reho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pihlajalinna Oyj, Tampere, Finland
| | - Salla Atkins
- New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mikko Korhonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Siukola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| | - Riitta Sauni
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
5
|
Tikka C, Verbeek J, Hoving JL, Kunz R. Evidence-informed decision about (de-)implementing return-to-work coordination to reduce sick leave: a case study. Health Res Policy Syst 2022; 20:19. [PMID: 35164766 PMCID: PMC8842546 DOI: 10.1186/s12961-022-00823-4] [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: 10/21/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordination of return to work (RtW) is implemented in many countries, but a Cochrane review found no considerable effect on workers' sick leave compared to usual care. The aim of the study is to analyse how the evidence from this review can be used for decisions about (de-)implementing RtW coordination in a country-specific setting, using Finland as an example. METHODS We conducted a systematic literature search and online survey with two groups of experts to compare interventions included in the Cochrane review to Finnish RtW practice using content analysis methods. We applied the evidence-to-decision (EtD) framework criteria to draw conclusions about (de-)implementing RtW coordination in Finland, including benefits, harms and costs of the intervention compared to usual care. RESULTS We included seven documents from the literature search and received data from 10 of 42 survey participants. RtW coordination included, both in Finland and in the review, at least one face-to-face meeting between the physician and the worker, a workers' needs assessment, and an individual RtW plan and its implementation. Usual care focuses on medical treatment and may include general RtW advice. RtW coordination would be cost-saving if it decreases sick leave with at least 2 days compared to usual care. The evidence in the Cochrane review was mainly of low certainty, and the effect sizes had relatively wide confidence intervals. Only a new, high-quality and large randomized controlled trial (RCT) can decrease the current uncertainty, but this is unlikely to happen. The EtD framework did not provide arguments for further implementation or for de-implementation of the intervention. CONCLUSIONS Interventions evaluated in the Cochrane review are similar to RtW coordination and usual care interventions in Finland. Considering all EtD framework criteria, including certainty of the evidence and costs, de-implementation of RtW coordination interventions in Finland seems unnecessary. Better evidence about the costs and stakeholders' values regarding RtW coordination is needed to improve decision-making.
Collapse
Affiliation(s)
- Christina Tikka
- Finnish Institute of Occupational Health, Neulaniementie 4, 70101, Kuopio, Finland.
| | - Jos Verbeek
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Coronel Institute of Occupational Health, Cochrane Work Review Group, Amsterdam, North Holland, The Netherlands
| | - Jan L Hoving
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Coronel Institute of Occupational Health, Cochrane Work Review Group, Amsterdam, North Holland, The Netherlands
| | - Regina Kunz
- Research Unit Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
6
|
Reho T, Atkins S, Korhonen M, Siukola A, Sumanen M, Viljamaa M, Uitti J, Sauni R. Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care - a follow-up study in Finland. BMC Public Health 2021; 21:1847. [PMID: 34641841 PMCID: PMC8507378 DOI: 10.1186/s12889-021-11873-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors. METHODS This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors. RESULTS In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time. CONCLUSIONS Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.
Collapse
Affiliation(s)
- Tiia Reho
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland. .,Pihlajalinna Työterveys, Tampere, Finland.
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Tampere University, New Social Research and Faculty of Social Sciences, Tampere, Finland
| | - Mikko Korhonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Anna Siukola
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Markku Sumanen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | | | - Jukka Uitti
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| | - Riitta Sauni
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| |
Collapse
|
7
|
Fear-Avoidance Behavior and Sickness Absence in Patients with Work-Related Musculoskeletal Disorders. ACTA ACUST UNITED AC 2020; 56:medicina56120646. [PMID: 33255875 PMCID: PMC7760519 DOI: 10.3390/medicina56120646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
(1) Background and objectives: The purpose of this work is to determine the association of fear-avoidance attitudes with sickness absence status, its duration and disability in a work accident context. (2) Materials and Methods: This is a descriptive observational design, conducting the study in two occupational insurance provider clinics with patients with nonspecific low back and neck pain during the study period. Clinical variables were the Fear Avoidance Questionnaire, Roland Morris Disability Questionnaire, Neck Disability Index, Numerical Pain Scale; sociodemographic variables were sex, age, occupational, educational level, sickness absence status, and duration in days of absence from work. Multiple logistic and linear regressions were used to explore the association between variables. (3) Results: Fear-avoidance behavior is related to sickness absence status (OR = 1.048, p = 0.007), and the physical activity dimension (OR = 1.098, p = 0.013) is more relevant than the work dimension (OR = 1.056, p = 0.028). The duration of sickness absence is related to higher values on the fear-avoidance behavior scale in its global dimension (b = 0.84, p = 0.003, r = 0.327), and the results of the physical activity dimension (B = 1.37, p = 0.035, r = 0.236) were more relevant than the work dimension (B = 1.21, p = 0.003, r = 0.324). Fear-avoidance behavior is related to disability in both dimensions (B = 0.912, p ˂ 0.001, r = 0.505). (4) Conclusions: Fear-avoidance behaviors may influence the typification of sickness absence status, its duration both in its physical activity and work dimension, and its disability reported with higher values than in other healthcare contexts.
Collapse
|
8
|
Reho TTM, Atkins SA, Talola N, Sumanen MPT, Viljamaa M, Uitti J. Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data. Scand J Public Health 2019; 48:181-189. [PMID: 30973068 PMCID: PMC7042497 DOI: 10.1177/1403494819838663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Frequent attendance in healthcare services is associated with ill-health and chronic illnesses. More information is needed about the phenomenon's connection with disability pensions (DPs). Methods: The study group comprised 59,676 patients divided into occasional- (1yFAs) and persistent frequent attenders (pFAs) and non-frequent attenders (non-FAs). Odds ratios for DP were analysed for these groups taking into account preceding sickness absence days. The awarded DPs were obtained from the Finnish Centre for Pensions and data on primary care visits were obtained from Pihlajalinna, a nationwide occupational healthcare provider. Results: 1yFAs and pFAs have more DPs than non-FAs. During follow-up, 14.9% of pFAs, 9.6% of 1yFAs and 1.6% of non-FAs had a DP decision of any kind. pFAs receive more partial and fixed-term decisions than the other groups and most permanent DPs are granted to 1yFAs. Musculoskeletal disorders are the most common reason for illness-based retirement in all groups but 1yFAs and pFAs have proportionally more mental disorders leading to DP. The group of non-FAs, on the other hand, has more DPs granted based on neoplasms. Both 1yFAs and pFAs have an increased risk of DP but the effect is diluted after taking into account preceding sick-leave. Conclusions: Frequent attendance of healthcare services, both occasional and persistent, is associated with increased risk of future DP. The association is linked to increased sickness absences. Frequent attenders should be identified and their rehabilitative needs evaluated. Frequency of consultation could be used in selecting candidates for early rehabilitation before sickness absences develop.
Collapse
Affiliation(s)
- Tiia T M Reho
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Pihlajalinna Työterveys, Tampere, Finland
| | - Salla A Atkins
- Tampere University, New Social Research and Faculty of Social Sciences, Tampere, Finland.,Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
| | - Nina Talola
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Markku P T Sumanen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | | | - Jukka Uitti
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
9
|
Reho T, Atkins S, Talola N, Sumanen M, Viljamaa M, Uitti J. Comparing occasional and persistent frequent attenders in occupational health primary care - a longitudinal study. BMC Public Health 2018; 18:1291. [PMID: 30477466 PMCID: PMC6260555 DOI: 10.1186/s12889-018-6217-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/14/2018] [Indexed: 11/12/2022] Open
Abstract
Background The aim of the study was to compare occasional and persistent frequent attenders in occupational health (OH) primary care and to identify the diagnoses associated with persisting frequent attendance. Methods This is a longitudinal study using electronic medical record data from 2014 to 2016 from an OH service provider. Frequent attenders were defined as patients in the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10). FA10 were categorized to three groups according to the persistence of frequent attendance (1-year-FA, 2 year-FA, and persistent-FA = frequent attenders in all three years). This was used as the dependent variable. We used patient sex, age, employer size, industry and distribution of visits and diagnostic codes to characterize the different frequent attender groups. Results In total, 66,831 patients were included, of which 592 persistent frequent attenders (0.9% of the study population) consulted the OH unit on average 13 times a year. They made altogether 23,797 visits during the study years. The proportion of women and employees of medium and large employers increased among persistent-FAs when compared to the other groups. Multinomial logistic regression accentuated musculoskeletal disorders and to a lesser extent diseases of the respiratory and nervous system and mental disorders. One in five FA becomes a persistent-FA. Conclusions Our results indicate that in the context of a working population the association of musculoskeletal disorders and persistent frequent attendance is emphasized. Persistent frequent attenders also create a substantial demand on physician resources. When planning interventions aimed at working age frequent attenders, subgroups suffering from musculoskeletal disorders should be identified as they are associated with persisting frequent attendance.
Collapse
Affiliation(s)
- Tiia Reho
- Faculty of Medicine and Life Sciences, University of Tampere, PB 100, FI-33014, Tampere, Finland. .,Pihlajalinna Työterveys, Tampere, Finland.
| | - Salla Atkins
- Faculty of Medicine and Life Sciences, University of Tampere, PB 100, FI-33014, Tampere, Finland.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Nina Talola
- Faculty of Medicine and Life Sciences, University of Tampere, PB 100, FI-33014, Tampere, Finland
| | - Markku Sumanen
- Faculty of Medicine and Life Sciences, University of Tampere, PB 100, FI-33014, Tampere, Finland
| | | | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, PB 100, FI-33014, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
| |
Collapse
|