Implementation of standardized time limits in sickness insurance and return-to-work: Experiences of four actors

Purpose: In 2008, time limits were introduced in Swedish sickness insurance, comprising a pre-defined schedule for return-to-work. The purpose of this study was to explore experienced consequences of these time limits. Sick-listed persons, physicians, insurance officials and employers were interviewed regarding the process of sick-listing, rehabilitation and return-to-work in relation to the reform. Method: The study comprises qualitative interviews with 11 sick-listed persons, 4 insurance officials, 5 employers and 4 physicians (n?=?24). Results: Physicians, employers, and sick-listed persons described insurance officials as increasingly passive, and that responsibility for the process was placed on the sick-listed. Several ethical dilemmas were identified, where officials were forced to act against their ethical principles. Insurance officials’ principle of care often clashed with the standardization of the process, that is based on principles of egalitarianism and equal treatment. Conclusions: The cases reported in this study suggest that a policy for activation and early return-to-work in some cases has had the opposite effect: central actors remain passive and the responsibility is placed on the sick-listed, who lacks the strength and knowledge to understand and navigate through the system. The standardized insurance system here promoted experiences of procedural injustice, for both officials and sick-listed persons.

Implications for Rehabilitation

• Ethical dilemmas may arise in implementing egalitarian policies, since they sometimes clash with insurance officials’ principles of care.

• A policy for activation and early return-to-work has in the reported cases led to more passive rehabilitation actors.

• Sick-listed persons experienced that they were given much responsibility, although lacking strength and knowledge to fulfil it.

     

改善医护人员与交流障碍患者之间的交流

目的探讨如何改善交流障碍患者与其护理人员之间的交流。方法在长期护理机构（L-TCFs）中对健康护理人员（HCPs）进行交流培训和使用交流工具箱,设立试验组和对照组用于评价交流培训和工具箱的有效性。结果和结论培训及工具箱并没有显著效果。但某些措施对交流有益,特别是给听力损伤患者增加辅助用具。此外,L-TCFs的本质决定了要做到成功有效的交流会遇到机构设置等方面造成的障碍,这一点在解释研究结果时需予以考虑。本领域需要更多的研究。     

Developing health and social care planning in collaboration

Abstract

Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.     

Piloting an email-based resource package for job seekers with multiple sclerosis

Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated.

• Implications for Rehabilitation

• Research indicates a high unemployment rate among working-age adults with MS.

• A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group.

• This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes.

• Work and MS has potential applicability to other disability groups.

     

Prognostic accuracy of the SIMBO regarding future return-to-work problems in patients with mental and musculoskeletal disorders

Purpose: A screening instrument (0–100 points) to predict return-to-work (RTW) problems was developed. We tested the predictive validity in patients with mental diseases (MD) and musculoskeletal diseases (MSD).

Materials and methods: A prospective multicenter study with questionnaires at admission and 3 months after rehabilitation was conducted. Patients with MD and MSD were included. The outcome was occurrence of RTW problems during the follow-up. Receiver operating characteristic analyses were performed. Sensitivity, specificity, and predictive values were calculated for each disease group using the threshold of 27 points.

Results: There were 401 patients with MD (n?=?250) and MSD (n?=?151) included in the study, and 31.8% and 46.4% reported RTW problems during the follow-up, respectively. The area under curve was 0.885 (0.838–0.920) and 0.899 (0.841–0.943). The sensitivity rates were 87.1% and 87.5% and the specificity rates were 79.9% and 88.4% for MD and MSD, respectively. The post-test probability of experiencing RTW problems was 78.9% for MD and 77.8% for MSD. Analyses including only employed patients showed similar results.

Conclusions: The screening predicts short-term RTW problems after rehabilitation in patients with mental or MSD regardless of employment. The threshold of 27 points was confirmed as reasonable, but alternatives in the range of 20–30 points can also be recommended.

• Implications for Rehabilitation

• The SIMBO is a short and economic screening predicting future problems during the return to work (RTW) in patients with mental or musculoskeletal diseases.

• The SIMBO can be recommended to detect the initial RTW chance at the beginning of the rehabilitation process.

• This paper implied that there are mainly generic factors predicting the success of an RTW. Based on this it is possible to use one screening for different disease groups.

     

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care

Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, ‘Enhancing Knowledge and Interprofessional Care for Heart Failure’, was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention’s acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.     

Job functions of Swedish public and private sector vocational rehabilitation workers

Purpose. This study has had two main aims, the first to investigate and gather knowledge of the major job functions of Swedish rehabilitation workers, the second to study the frequency of use of these functions in the VR process.

Method. Structured questionnaires were sent to Swedish rehabilitation workers from public and private sectors. To identify the major dimensions of Swedish rehabilitation workers' job in the vocational rehabilitation (VR) process, a principal component factor analysis was performed.

Results. Results revealed that there are four main factors (dimensions) that comprised the VR process in Sweden. The four factors (dimensions) are job development and career counselling; assessment and counselling interventions; workplace adjustment and employer consultation and client support, personnel development and public relations.

Conclusions. The VR process in Sweden is limited in both its scope and depth. This when one compares with the results of studies carried out in the USA, who found seven and six dimensions, respectively. It is argued that it cannot be excluded that the negative trend of extensive sick leave and early pensions are attributable to the limitations in the VR process that have been found. Suggested is the urgent need to put resources in place that would support the further advancement of the knowledge and competencies of the VR services in Sweden.     

Cooperation of return-to-work professionals: the challenges of multi-actor work disability management

Purpose: This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders.

Method: The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis.

Results: The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise.

Conclusions: The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field.

• Implications for Rehabilitation

• Cooperation between RTW professionals in public employment offices and other organizations involved in work disability management was considered inadequate.

• In order to improve the cooperation of RTW professionals, the stakeholders need to create more systematic ways of communication and networking with professionals in other organizations.

• There is a need to expand the expertise in work disability management and rehabilitation, partly by increasing the role of other professionals than physicians.

     

Violence Against Health Care Providers: A Mixed-Methods Study from Karachi,Pakistan

Background

Violence against health care providers (HCPs) remains a significant public health problem in developing countries, affecting their performance and motivation.

Satisfaction of health‐care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates

The integration of electronic health records (EHRs) has shown promise in improving health‐care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross‐sectional survey of 680 health‐care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes.     

辅助沟通系统概要

在中国,康复及相关专业在近十年发展快速,生活质量成为急性医疗照护之后的首要重点。沟通是人类特有且重要的技能,也是影响生活质量的重要因素之一。人类利用沟通将想法分享给其他人,也用沟通为自己的权益发声。本文宗旨是介绍辅助沟通的基本概念,包含辅助沟通简介、辅助沟通类型、可从辅助沟通获益的族群、辅助沟通语言介入服务原则,以及跨专业团队成员角色讨论。     

养老机构护理员临终关怀知识、态度、行为现状及其影响因素

目的探讨养老机构护理员临终关怀知识、态度、行为现状及其影响因素。方法 2016年1-5月,便利抽样法选择宁波市20所养老机构的351名养老护理员为研究对象。采用临终关怀知识、态度及行为量表对其进行调查,分析养老护理员临终关怀知识、态度、行为现状及其影响因素。结果养老护理员临终关怀知识、态度、行为评分分别为(0.65±0.15)、(3.47±0.23)、(3.96±0.60)分。不同学历、工作年限的养老护理员,其临终关怀知识评分差异均有统计学意义(均P0.05);不同年龄、职称、家庭型态、临终关怀知识来源及临终关怀知识总均分的养老护理员,其临终关怀态度评分差异均有统计学意义(均P0.05);不同家庭型态、临终关怀知识来源及临终关怀态度评分的养老护理员,其临终关怀行为评分差异亦有统计学意义(均P0.05)。学历和工作年限是养老护理员临终关怀知识评分的主要影响因素;年龄、职称、家庭型态、临终关怀知识来源、临终关怀知识是养老护理员临终关怀态度评分的主要影响因素;家庭型态、临终关怀知识来源和临终关怀态度是养老护理员临终关怀行为评分的主要影响因素(均P0.05)。结论养老机构护理员的临终关怀知识水平较低,临终关怀知识来源渠道局限,应重视养老护理员的临终关怀教育培训。