Hultberg Eva-Lisa, Lönnroth Knut, Allebeck Peter, Hensing Gunnel
Department of Social Medicine, The Sahlgrenska Academy at Göteborg University, Sweden. eva-lisa@
Work. 2006;26(4):369-77.
The aim of the study was to assess if health care centres with a co-financing model for collaborative rehabilitation between primary health care, sickness insurance offices and social welfare offices reduced sick leave among persons with musculoskeletal disorders compared to health centres with conventional rehabilitation structures.
A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed. In addition, we collected register data about patients' allowances for sick leave days for totally 18 months.
The intervention group had an average of 94 days and the controls 87 days on sick leave during the 12-months period after inclusion in the study. At 12 months the proportion of patients sick listed was 31% in the intervention group and 32% in the control group.
The study could not show that the co-financing model reduced the numbers of sick leave days among patients with musculoskeletal disorders. A possible explanation for the lack of positive impact on patients' health or work ability might be that the working procedure has in fact not really been changed and the tool mix lack solid evidence. The study identifies some methodological problems addressed in future research trying to link organisational changes with patient outcomes.
本研究旨在评估与具有传统康复结构的健康中心相比,采用初级医疗保健、疾病保险办公室和社会福利办公室合作康复共同融资模式的医疗保健中心是否能减少肌肉骨骼疾病患者的病假天数。
进行了一项比较性前瞻性研究。对连续就诊于采用共同融资模式(n = 107)和未采用共同融资模式(n = 31)的医疗保健中心的16 - 64岁肌肉骨骼疾病患者进行了访谈。此外,我们收集了患者总共18个月病假天数补贴的登记数据。
在纳入研究后的12个月期间,干预组平均病假天数为94天,对照组为87天。在12个月时,干预组病假登记患者的比例为31%,对照组为32%。
该研究未能表明共同融资模式减少了肌肉骨骼疾病患者的病假天数。对患者健康或工作能力缺乏积极影响的一个可能解释是,工作程序实际上并未真正改变,且工具组合缺乏确凿证据。该研究确定了未来研究中试图将组织变革与患者结果联系起来时需要解决的一些方法学问题。