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Hällås E, Skoglund I, Nordeman L. "That's probably how you would want care to be" - experiences of sick leave teams at a health center, a mixed method study. BMC PRIMARY CARE 2023; 24:243. [PMID: 37978438 PMCID: PMC10655286 DOI: 10.1186/s12875-023-02192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The health center where this study was performed the management wanted to test whether a sick leave team provided the physicians with better conditions for the task of assessing sick leave. The goals were to ensure the quality of the assessment of patients with sick leave needs and to improve the work environment. The aim of this study was to take part in the staff's experiences of having access to and working in sick leave teams and how the working method affected the number of sick leave patients and sick leave pattern. METHODS A mixture of qualitative and quantitative methods. Two focus groups were conducted with a total of 11 participants. The head of the health center formed the focus groups, which consisted of 6 doctors, 3 district nurses, 1 rehab coordinator and 1 psychologist. Aggregated sick leave data for full-time and part-time sick leave of more than 90, 180 and 360 days, respectively, were obtained and compiled at project start and end, and from the corresponding period 18 months before project start. RESULTS The introduction of sick leave teams with physicians and rehabilitation coordinator for patients who turn to the health center for mental illness and / or musculoskeletal problems emerged three main categories from the analysis of the focus group discussions: working environment, clear roles and in-depth competence. The total number of people who were on sick leave more than 365 days decreased by 27% between start and the end of the project, and the proportion of women increased by 11%. CONCLUSIONS The study shows that the complex task of sick leave can be perceived as positive by physicians with the support of teamwork. The working method is similar to that applied in occupational health care, where the physician is not alone with this task. This can also be a way to make primary care a more attractive workplace.
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Affiliation(s)
- E Hällås
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden.
| | - I Skoglund
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Nordeman
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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2
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Hensing G, van Diepen C, Boström M, Bertilsson M. Validity of the Capacity to Work Index: Development of an Instrument to Measure Work Capacity in Relation to Depression and Anxiety in the General Working Population. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10150-2. [PMID: 37938436 DOI: 10.1007/s10926-023-10150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To develop an index to assess capacity to work in relation to common mental disorders (CMDs) in the general working population and field test its psychometric properties. METHODS Content analysis of three qualitative studies on people (n = 49) with their own experiences of working with CMD guided the items selected for the index. Face and content validity and test-retest reliability were performed. The index was field tested in two versions with 26 and 17 items, respectively, among health care professionals regarding internal reliability, component structure and concurrent validity. RESULTS The final version of the Capacity to Work Index (C2WI; 17 items) was normally distributed in the field test with high internal reliability (Cronbach's alpha, 0.84). Missing responses were randomly distributed and nonspecific. Principal component analysis showed one clear component with negatively framed items. Concurrent validity showed high correlation with the WHO-5 Well-Being Scale (Pearson's r, 0.68), but lower correlation for the general health question (r, - 0.44), one item of the Work Ability Index (r, - 0.33), and the Stress of Conscience constructs (r, 0.44). CONCLUSION The C2WI showed promising psychometric qualities. Low and negative correlation with the item from Work Ability Index suggests that the C2WI measures additional dimensions, but further testing in larger and more diverse samples is required.
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Affiliation(s)
- Gunnel Hensing
- Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
- Social Medicine, School of Public Health and Community Medicine, PO Box 453, SE-405 30, Göteborg, Sweden.
| | - Cornelia van Diepen
- Centre for Person-centred Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maria Boström
- Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Monica Bertilsson
- Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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3
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Beno A, Bertilsson M, Holmgren K, Glise K, Pousette A, Segerfelt K, Björk L. Does employer involvement in primary health care enhance return to work for patients with stress-related mental disorders? a cluster randomized controlled trial. BMC PRIMARY CARE 2023; 24:195. [PMID: 37730561 PMCID: PMC10512560 DOI: 10.1186/s12875-023-02151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with collaboration between general practitioners (GPs), rehabilitation coordinators (RCs) and employers could reduce sick leave days for this patient group. METHOD Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (n = 54), following the systematic intervention procedure, or the control group (n = 58), receiving treatment as usual (TAU). The intervention included a) a training day for participant GPs and RCs, b) a standardised procedure for GPs and RCs to follow after training, c) the opportunity to receive clinical advice from specialist physicians in the research group. Outcome measures for RTW were sick leave days. RESULTS The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (p = 0.03) at six months (p = 0.00) and at 12-months follow-up (p = 0.01). At 24 months, this difference was no longer significant. CONCLUSIONS The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed. The study was registered on 16/01/2017 (ClinicalTrials.gov, NCT03022760).
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Affiliation(s)
- Anja Beno
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottsbergs Gata 22B, SE-413 19, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Monica Bertilsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kristina Glise
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottsbergs Gata 22B, SE-413 19, Gothenburg, Sweden
| | - Anders Pousette
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- The Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Karin Segerfelt
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottsbergs Gata 22B, SE-413 19, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lisa Björk
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottsbergs Gata 22B, SE-413 19, Gothenburg, Sweden
- The Department of Work Science and Sociology, University of Gothenburg, Gothenburg, Sweden
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Hultqvist J, Hensing G, Stansfeld S, Bertilsson M. Managers' sick leave recommendations for employees with common mental disorders: a cross-sectional video vignette study. BMC Psychol 2023; 11:52. [PMID: 36829249 PMCID: PMC9951527 DOI: 10.1186/s40359-023-01086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/13/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND To better understand the initial phases of sickness absence due to common mental disorders (CMD), the aim of the present video vignette study was to test the following three hypotheses: (1) Managers who have negative attitudes towards employees with CMD will not recommend sick leave. (2) Managers with experience of CMD recommend sick leave to a significantly higher extent than managers lacking this experience. (3) Managers with previous experience of recommending sick leave for people with CMD will recommend sick leave to a significantly higher extent also based on the vignettes. METHODS An online survey, including a CMD-labelled video vignette, was sent to 4737 Swedish managers (71% participated, n = 3358). For aims (1) and (2), a study sample consisting of 2714 managers was used. For aim (3), due to the design of the survey questions, a subsample (n = 1740) was used. RESULTS There was no significant association between negative attitudes towards employee depression and managers' recommendation of employee sick leave with the vignette case. The bivariate analysis showed that personal experience of CMD was associated with managers' recommendation of employee sick leave. In the adjusted regression model, it became non-significant. Previous experience of recommending sick leave to one employee and to several employees was associated with recommending sick leave, also when adjusting for gender, level of education, years of managerial experience, and management training on CMDs CONCLUSIONS: The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was higher if the manager had previous experience of this situation in real life. This study highlights the importance of including managerial behaviours and attitudes to better understand sick leave among employees with CMD.
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Affiliation(s)
- Jenny Hultqvist
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg University, PO Box 455, 405 30, Gothenburg, Sweden.
| | - Gunnel Hensing
- grid.8761.80000 0000 9919 9582School of Public Health and Community Medicine, Gothenburg University, PO Box 463, 405 30 Gothenburg, Sweden
| | - Stephen Stansfeld
- grid.4868.20000 0001 2171 1133Centre for Psychiatry, Queen Mary University of London, Mile End Road, London, E1 4NS Great Britain UK
| | - Monica Bertilsson
- grid.8761.80000 0000 9919 9582School of Public Health and Community Medicine, Gothenburg University, PO Box 463, 405 30 Gothenburg, Sweden
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Drolet L, Caron PO, Forget J, Turcotte JR, Guimond C. Family physicians' sick-listing practices in relation to mental disorders: A descriptive study. Work 2022; 75:211-221. [PMID: 36591671 DOI: 10.3233/wor-211301] [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: 12/31/2022] Open
Abstract
BACKGROUND Mental disorders are among the leading causes of disability for which family physicians are often required to complete sickness certificates. Yet, little is known about family physicians' sick-listing practices in Quebec. OBJECTIVE This study aims to describe their practices, difficulties and needs. METHODS Twenty-three family physicians completed a comprehensive questionnaire on sickness certification practices. Descriptive statistics were used. RESULTS Despite being completed on a weekly basis, sickness certifications were deemed problematic by all participants. While they rarely refused to sick-list a patient, 43.5% reported suggesting accommodations as an alternative to sick leave. Waiting-time to access psychotherapy and delays to set-up workplace accommodations are responsible for many unnecessary sick-leave prolongations. Lack of time, long duration absences, situations where the physician held a different opinion than the patient/healthcare provider and assessing an individual's capacity to work are the most common reported problems. More than half of participants indicated medical schools do not greatly prepare them to carry out these tasks. CONCLUSION Sickness certifications are deemed problematic, and more training might be key. Our results can be used by medical schools or bodies responsible for continuous education to improve training.
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Affiliation(s)
| | | | | | | | - Claude Guimond
- Fédération des Médecins Omnipraticiens du Québec, Quebec, QC, Canada
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6
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Tengelin E, Hensing G, Holmgren K, Ståhl C, Bertilsson M. Swedish managers' experience-based understanding of the Capacity to work in employees with Common Mental Disorders: a Focus Group Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:685-696. [PMID: 35246799 PMCID: PMC9668926 DOI: 10.1007/s10926-022-10029-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Understanding of the capacity to work among employees with common mental disorders (CMDs) is important, but contemporary knowledge on this issue lacks the managers' perspective. The aim of this study was to explore and describe managers' experience-based understanding of capacity to work in employees with CMD. METHODS A qualitative focus group study was designed. Managers with experience in supporting employees with CMD were recruited via organizations and networks. Eight focus group interviews with 31 participants took place. RESULTS The analysis resulted in five categories. (1) Capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) Capacity to commit to continuous and coherent task changes, making tasks that span longer periods of time difficult. (3) Capacity to independently adapt to the needs of the situation decreases, and employees need more guidance and instructions than usual. (4) Capacity to keep up professional appearances is reduced, and the employees struggle with the professional role. (5) Ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace. CONCLUSIONS This study adds managers' perspective to the increasing knowledge on how capacity to work is influenced by CMDs. Managers understand CMDs in employees as changed, reducing the capacities needed for occupational functioning. A deeper understanding of reduced capacity to work is needed to adapt workplaces, and our findings can facilitate work accommodations for employees with CMDs.
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Affiliation(s)
- Ellinor Tengelin
- Department for Health Sciences, University West, SE-461 86, Trollhattan, Sweden.
| | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, SE-405 30, Gothenburg, Sweden
| | - Christian Ståhl
- Department of Behavioural Sciences and Learning, Division of Education and Sociology, Linköping University, SE-581 83, Linköping, Sweden
| | - Monica Bertilsson
- Insurance Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, SE-405 30, Gothenburg, Sweden
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Furlan AD, Harbin S, Vieira FF, Irvin E, Severin CN, Nowrouzi-Kia B, Tiong M, Adisesh A. Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:591-619. [PMID: 35511378 DOI: 10.1007/s10926-022-10043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.
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Affiliation(s)
- Andrea D Furlan
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada.
- KITE, University Health Network, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Shireen Harbin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Fabricio F Vieira
- Faculty of Medicine, State University of Maringa, Avenida Colombo, 5790, CEP 87020-900, Maringa, PR, Brazil
| | - Emma Irvin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret Tiong
- Institute for Work & Health, 400 University Avenue, suite 1800, Toronto, ON, M5G 1S5, Canada
| | - Anil Adisesh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Occupational Medicine, St Michael's Hospital, Toronto, ON, Canada
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Nordling P, Jakobsson A, Hensing G. The Capacity Note: a communication facilitator in the sick leave process of patients with common mental disorders - a qualitative study of user perceptions. BMJ Open 2022; 12:e054436. [PMID: 35487752 PMCID: PMC9058774 DOI: 10.1136/bmjopen-2021-054436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the development of a communication facilitator, the Capacity Note, for the sick leave process of patients with common mental disorders (CMDs) in primary care, and to explore users' perceptions of it. DESIGN Qualitive study. SETTING Primary healthcare in Region Västra Götaland, Sweden. PARTICIPANTS AND METHODS The Capacity Note was developed inductively based on data from six qualitative studies of work capacity and CMD and was introduced at primary healthcare centres during 2018-2019. Individual semistructured interviews were performed with 13 informants (8 patients, 2 general practitioners and 3 managers) who had used the Capacity Note at least once. Interviews were audiorecorded and transcribed verbatim and inductive manifest qualitative content analysis was used to analyse the data. RESULTS The Capacity Note comprised questions about work situation, work capacity limitations and possible work adjustments. Based on the interviews, four categories relating to its role as a facilitator for communication about work and health were identified: content and format, understanding, legitimacy and action, openness and timing, and time and efficiency. The participants considered the Capacity Note relevant and easy to use, and as having the potential to improve communication about and understanding of the patient's situation. The increased understanding was perceived as contributing to a sense of legitimacy and agency. Achieving these benefits required, according to the participants, openness, an investment of time and using the Capacity Note at the right time in the sick leave process. CONCLUSION The Capacity Note was found to be relevant and as having, under the right conditions, the potential to improve communication and facilitate the sick leave process.
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Affiliation(s)
- Paula Nordling
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Healthcare, Region Västra Götaland, Gothenburg, Sweden
| | - Annika Jakobsson
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Serrano-Zamago AB, Altamirano-Bustamante MM. Appealing to Tacit Knowledge and Axiology to Enhance Medical Practice in the COVID-19 Pandemic: A Systematic Review and Hermeneutic Bioethical Analysis. Front Public Health 2021; 9:686773. [PMID: 34956997 PMCID: PMC8692268 DOI: 10.3389/fpubh.2021.686773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pressure of coronavirus disease 2019 (COVID-19) pandemic, epidemiological and demographic changes, personnel-patient relationship in healthcare, and the development of biotechnologies do not go unnoticed by the healthcare professional. Changes are so wide and at a high rate that guidelines and mere scientific knowledge, which are represented by evidence-based medicine, are not sufficient to lead actions, thus the experiential aspects in the configuration of an ethos present as a fundamental part of the resources to deal with critical scenarios, such as a pandemic. In this regard, the recognition of tacit knowledge as a way of teaching and learning skills related to ethical aspects such as principles, virtues, and values, revealed as a fundamental part of the clinical field. The challenge is to strengthen binomial evidence-based medicine and values-based in order to achieve excellence in the health care of the patients and the well-being of the clinical personnel. Method: A 2-fold analysis was conducted taking pediatric endocrinology as an example. First, a systematic review was carried out in electronic databases BIREME, PubMed, and PhilPapers following PEO and PRISMA approaches. A total of 132 articles were garnered. After reading their title and abstract, 30 articles were obtained. Quantitative information was arranged in an Excel database according to three themes: ethics, axiology, and tacit knowledge. A quality criterion that meets our research question was assigned to each article and those which had a quality criterion of 3 (9) were taken to carry out the hermeneutic bioethical analysis, which consisted of three stages, namely naïve reading, codification, and interpretation. The results were analyzed in Atlas.ti. to elucidate the relations between the three main themes in accordance with the objective. Results: Although there was no difference in the frequency of tacit knowledge skills, including cognitive, social, and technical, for medical practice, there is an intrinsic relationship between epistemic and ethical values with cognitive skills, this means that professionals who practice honesty, authenticity and self-control are capable of seeing patients as persons and thus respect their dignity. This suggested that there is a strong partnership between evidence-based medicine and value-based medicine, which reinforced this binomial as the two feet on which medical practice decisions rested. With regard to tacit knowledge in terms of the context of the COVID-19 pandemic, the challenges refer to (1) adapting and learning a new way of establishing trust with the patient and (2) how to capitalize on the new knowledge that new experiences have posed. Discussion: The analysis of ethical-tacit knowledge in medicine is a recent phenomenon and is in full development. Although no references were found that dealt with any of the main topics in pediatric endocrinology, there is an interest in pediatrics to explore and discuss educational strategies in ethics related to its tacit dimension as a vector of enhancement in the clinical practice. Educational strategies ought to take into consideration the development of skills that promote reflection and discussion of experiences, even more vigorously in the context of the COVID-19 pandemic.
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Affiliation(s)
- Ana-Beatriz Serrano-Zamago
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Myriam M Altamirano-Bustamante
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
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10
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Karlsson EA, Sandqvist JL, Seing I, Ståhl C. Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective. Work 2021; 70:109-124. [PMID: 34487009 PMCID: PMC8543242 DOI: 10.3233/wor-213558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures. OBJECTIVE: The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system. METHODS: This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis. RESULTS: Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone. CONCLUSION: The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.
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Affiliation(s)
- Elin A Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan L Sandqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Ida Seing
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Christian Ståhl
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
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11
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Duchaine CS, Aubé K, Gilbert-Ouimet M, Vézina M, Ndjaboué R, Massamba V, Talbot D, Lavigne-Robichaud M, Trudel X, Pena-Gralle APB, Lesage A, Moore L, Milot A, Laurin D, Brisson C. Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2020; 77:842-851. [PMID: 32236498 PMCID: PMC7113841 DOI: 10.1001/jamapsychiatry.2020.0322] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. OBJECTIVE To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. DATA SOURCES Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. STUDY SELECTION Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. DATA EXTRACTION AND SYNTHESIS This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. MAIN OUTCOMES AND MEASURES Sickness absence due to a mental disorder with a diagnosis obtained objectively. RESULTS A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). CONCLUSIONS AND RELEVANCE This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.
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Affiliation(s)
- Caroline S. Duchaine
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Karine Aubé
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada
| | | | - Michel Vézina
- Institut national de santé publique du Québec, Quebec City, Québec, Canada
| | - Ruth Ndjaboué
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
| | - Victoria Massamba
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Denis Talbot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Mathilde Lavigne-Robichaud
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Xavier Trudel
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Ana-Paula Bruno Pena-Gralle
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montreal, Québec, Canada
| | - Lynne Moore
- Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Alain Milot
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Danielle Laurin
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada,Faculty of Pharmacy, Laval University, Quebec City, Québec, Canada
| | - Chantal Brisson
- CHU de Québec-Laval University Research Centre, Quebec City, Québec, Canada,Faculty of Medicine, Laval University, Quebec City, Québec, Canada,Centre de recherche sur les soins et les services de première ligne de l’Université Laval, Quebec City, Québec, Canada
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12
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Nordling P, Priebe G, Björkelund C, Hensing G. Assessing work capacity - reviewing the what and how of physicians' clinical practice. BMC FAMILY PRACTICE 2020; 21:72. [PMID: 32340611 PMCID: PMC7187489 DOI: 10.1186/s12875-020-01134-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Abstract
Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.
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Affiliation(s)
- P Nordling
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden. .,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
| | - G Priebe
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
| | - C Björkelund
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
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13
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von Allmen DY, Kedzia S, Dettwiler R, Vogel N, Kunz R, de Boer WEL. Functional Interviewing Was Associated With Improved Agreement Among Expert Psychiatrists in Estimating Claimant Work Capacity: A Secondary Data Analysis of Real-Life Work Disability Evaluations. Front Psychiatry 2020; 11:621. [PMID: 32719624 PMCID: PMC7350701 DOI: 10.3389/fpsyt.2020.00621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Functional evaluations establish functional and work (in-)capacities in the context of disability assessments and are increasingly recommended as a modern technique for work disability assessments. The RELY (Reliable disability EvaLuation in psychiatrY)-studies introduced semi-structured functional interviews in real-life assessments of claimants with mental disorders for evaluating their self-perceived health-related limitations and for investigating the reproducibility of work capacity (WC) estimates. Functional interviews elicit claimants' self-perceptions about their work-related limitations and capacities in the labour market. This secondary data analysis explored the coverage of work-related key topics in these interviews and investigated whether interviews with high coverage (versus low coverage) of work-related topics resulted in better reproducibility of WC estimates among experts. METHODS Thirty video-taped RELY-assessments underwent a content analysis along a predefined framework for functional interviewing, including the claimant's self-perceived work limitations and work-related health complaints as centrepieces of functional interviewing. Following transcription, interviews were segmented into coding units. Coding units were allocated to the five steps with 19 key topics of the framework. Enquiry into key topics was ascertained by summing the functional coding units per key topic. Median split grouped the interviews into high and low coverage of functional topics and compared them for inter-rater reliability (intraclass correlation coefficient, ICC) and inter-rater agreement (standard error of measurement, SEM). RESULTS Interviews were broken down in 40,010 coding units, 31% of which addressed functional topics. Enquiries in self-perceived work limitations and work-related health complaints were sparse (coding units medianpsychiatrist between 0 and 1.5, medianpatients between 0 and 9.5). High coverage interviews enquired on more functional topics (68% vs. 42%, chi2(1, N = 38) = 5.32, p = 0.021) and in more depth (36% vs. 16% of functional coding units, chi2(1, N = 1,314) = 141.15, p < 0.001). Interviews with higher functional coverage reached significantly higher inter-rater agreement in WC ratings among experts (mean difference in SEM, low-high coverage, 7.5% WC, 95% CI 0.2 to 15.1%WC). Inter-rater reliability was low in both groups (ICC, 0.38 versus 0.40). CONCLUSIONS Content analysis showed little enquiry by experts on claimants' self-perceived activity limitations and work-related capacity. The association between interviews with higher functional coverage and better expert agreement on the claimants' remaining WC requires confirmation in prospective studies.
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Affiliation(s)
- David Y von Allmen
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
| | - Sarah Kedzia
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
| | - Raphael Dettwiler
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
| | - Nicole Vogel
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
| | - Regina Kunz
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
| | - Wout E L de Boer
- Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital of Basel, Basel, Switzerland
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14
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van den Heuvel SCGH, Goossens PJJ, Terlouw C, Schoonhoven L, van Achterberg T. Self-Management Education for Bipolar Disorders: A Hermeneutic-Phenomenological Study on the Tacit Knowledge of Mental Health Nurses. Issues Ment Health Nurs 2019; 40:942-950. [PMID: 31381457 DOI: 10.1080/01612840.2019.1636166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Self-management of bipolar disorder (BD) education is a complex nursing intervention in which patients and informal caregivers are taught to be actively involved in self-monitoring and self-regulating activities. Some studies question if nurses are sufficiently equipped to deliver these educational tasks. Other studies suggest that nurses have gathered their knowledge implicitly by experience, but to date, this tacit knowledge is not described from the experiences of mental health nurses (MHNs) in ambulant BD care. Objective: To detect the tacit knowledge used by MHNs by interpreting their experiences in delivering self-management education to people with BD and their informal caregivers. Methods: A phenomenological-hermeneutical study amongst MHNs (N = 9) from three ambulant BD care clinics in the Netherlands. Face-to-face, open, in-depth interviews guided by a topic list, were conducted and transcribed verbatim prior to the hermeneutical analysis. Findings: We found five categories resembling the complex character of self-management interventions provided by MHNs: Building a trustful collaboration, Starting a dialogue about needs and responsibilities, Explaining BD, Utilizing mood monitoring instruments, and Conceptualizing self-management of BD. Conclusion: Eventually MHNs use tacit knowledge to cope with situations that demand an outside-the-box approach. Self-management education is partially trained and partially mastered through experience. Practice implications: In order to facilitate long-term self-management of BD, the collaboration of a supporting network is essential.
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Affiliation(s)
- S C G H van den Heuvel
- Expertise Centre for Health, Social Care and Technology, Saxion University of Applied Sciences , Deventer , The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
| | - P J J Goossens
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University , Ghent , Belgium
| | - C Terlouw
- Expertise Centre for Educational Innovations, Saxion University of Applied Sciences , Deventer , the Netherlands
| | - L Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton , Southampton , UK
| | - T van Achterberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
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