Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Department of Social Work, Södertörn University, Huddinge, Sweden.
Disabil Rehabil. 2023 Sep;45(18):2915-2924. doi: 10.1080/09638288.2022.2114019. Epub 2022 Aug 25.
The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' RTW processes from the perspective of coordinators in different clinical areas in Sweden.
Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory.
Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures.
Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. Implications for rehabilitationRTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership.In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination.There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.
患有多种疾病和心理社会困难的人重返工作岗位 (RTW) 的过程可能很复杂。本研究从瑞典不同临床领域的协调员的角度探讨了协调这些患者 RTW 过程的组织前提条件。
对在初级保健 (PHC)、精神科和骨科诊所工作的 24 名协调员进行了 6 次焦点小组访谈。数据采用组织理论为灵感进行主题分析。
协调员对患有多种疾病和心理社会困难的人描述了不同的方法，PHC 协调员的态度较为犹豫，其他协调员认为他们阻碍了患者在临床科室之间的流动。大多数 RTW 的组织障碍在医疗保健部门被发现。这些障碍包括长时间的等待时间、医生制定的不充分的 RTW 计划、协调员在病假过程中参与较晚、以及缺乏针对患有多种疾病的人的康复计划。与社会保险局和就业服务等组织相关的障碍是由法规以及不同的观点、优先事项和程序造成的。
我们的研究结果表明，需要改善有复杂情况的患者的 RTW 过程：改善工作条件、指导和指导方针；缩短等待时间；以及来自不同临床领域的协调员之间围绕患者进行合作的意愿。
RTW 协调员需要足够的身体和心理社会工作条件以及明确的领导力。为了避免在获得 RTW 支持方面的不平等，需要更好的系统来识别那些受益于康复和 RTW 协调的患者。需要在临床科室之间进行多层次的合作，以便那些有多次医疗接触和长时间病假的患者能够在 RTW 过程中获得支持。
