Zusammenfassung Ziel der Studie Zurzeit wird in Deutschland keine Statistik darüber geführt, wie viele Personen mit einer zeitlich befristeten Erwerbsminderungsrente (EM-Rente) ein Return to Work (RTW) realisieren. Ziel dieser Studie ist es zu prüfen, wie viele Personen, die 2006 zum ersten Mal eine zeitlich befristete EM-Rente erhalten haben, ein RTW erreichten und welche soziodemografischen, gesundheitlichen und beruflichen Merkmale diese Personen aufweisen. Methodik Der Scientific Use File „Abgeschlossene Rehabilitation 2006–2013 im Versicherungsverlauf“ des Forschungsdatenzentrums der Deutschen Rentenversicherung wurde ausgewertet. Als RTW wurde gewertet, wenn eine Person nach Berentung in einem der 7 Folgejahre an 183–365 Tagen mindestens einer Halbtagsbeschäftigung nachging und dafür wenigstens 8,50 Euro/Stunde erhielt. Die Entwicklungen der Kohorte wurden deskriptiv ausgewertet. Der Zusammenhang von soziodemografischen, gesundheitlichen und beruflichen Merkmalen der Personen und dem RTW wurde durch Cox-Regressionen ermittelt. Ergebnisse Von der Ausgangskohorte (N=9.789) erreichten in dem Beobachtungszeitraum 5,9% ein RTW. Von diesen erreichten ca. 25% ein RTW in jedem Folgejahr. Im Beobachtungszeitraum verstarben 10,6%, 9,1% gingen in Altersrente und 1,4% erhielten eine unbefristete EM-Rente. Die Regressionsanalyse zeigt, dass soziodemografische, gesundheitliche und berufliche Merkmale der EM-Rentner/innen in signifikantem Zusammenhang mit einem RTW stehen: EM-Rentner/innen im Alter von 18–39 Jahren, mit einer somatischen Rentenbewilligungsdiagnose, einer medizinischen Rehabilitation oder einer Erwerbstätigkeit vor der EM-Rente haben die höchste Wahrscheinlichkeit auf ein RTW. Schlussfolgerung Die Ergebnisse zeigen, dass nur wenige Personen ein RTW aus der EM-Rente erreichen. Es könnte einerseits geschlussfolgert werden, dass die Kriterien für eine zeitliche Befristung von EM-Renten geschärft werden sollten, um dadurch z. B. den Arbeitsaufwand für Wiederbegutachtungen zu verringern. Andererseits könnte auch ein deutlicher Unterstützungsbedarf der EM-Rentner/innen bei der Realisierung eines RTW und ein dafür notwendiger Forschungsbedarf postuliert werden.
It seems that classic vocational rehabilitation for insurants who already receive a disability pension does not lead to a higher rate of reintegration into work. The relatively large number of insurants who want to return to their jobs implies the necessity of a special rehabilitation programme with concepts for reintegration: an individual case-management should help to continually counsel the patients and, by means of work-trial phases, prepare them for their return into their career.
Especially employers perceived rehabilitation positively and reported good experiences. Among the employees, those who had taken part in rehabilitation showed the highest appreciation. Occupational health practitioners were more restrained in their appraisal. Some of them complained about a lack of sustainability. The different target groups of the survey felt differently well informed about rehabilitation - best ratings came from the occupational health practitioners, worst ratings from the employees. All groups would welcome more accessible information in case of need. Medical rehabilitation in its standard form of "3 weeks full-time" often causes severe logistic problems in SME (e. g., replacement of employee, loss of experience). However the financial burden is perceived as less problematic. Employers favour alternative rehab models, which allow part-time working. Many employees, who expressed a need for rehabilitation, refrained from applying for rehabilitation on account of worries about loosing their employment. Both rehab clinicians and occupational health practitioners argued in favour of improved communication and cooperation in order to adapt medical rehab to the specific requirements of the working place and to assure a smooth reintegration into work.
Disability assessment is a complex and multifaceted process of exploration and evaluation, which in terms of legal evidence can be of far-reaching consequence for the claimant, the statutory pension insurance and finally for society as well. In the article the specifics of the assignment, the assessment situation, and the process of evaluation are described. Based upon an analysis of the so far only little research activities, the future need for research is subdivided into 4 thematic groups: 1 Operationalization and validation of central dimensions of evaluation; 2 Investigation of the structure of the expert decision-making process and the factors influencing it; 3 Investigation of the influence of sociopolitical, labour market-related and economical aspects on the evaluation; 4 Quality assurance. On the other hand the article describes the special quality of disability assessment. In a unique way it offers an integrated reflection of the medical history, limitation in capacity and participation and options for treatment and rehabilitation. Beyond the assessment of functional capacity, it could be of use for the development of innovative forms of support for the rehabilitation of working capacity.
There is little research on the process of decision making in sociomedical expert opinion especially on prognostic issues. Experts therefore have to rely upon experience and their own routines of judgement. The IREPRO List of Indicators offers a systematic scheme for the sociomedical exploration and evaluation of the prognosis for reintegration and the need for rehabilitation in claimants for disability pension due to mental illness. A set of ten indicators was defined and its practical use tested in an expert-based process of development. In a manual each indicator is thoroughly described in a standardized manner including a five-point rating scale. In a profile sheet the ratings of all ten indicators are visualized, appropriate therapeutical and rehabilitative means are assigned, and the final judgement of prognosis is deduced. At present the IREPRO List of Indicators offers a good tool to structure the process of decision making and contributes to enhancing transparency and uniformity of the process. It can also be used to discuss cases among colleagues. The basic principle can be transferred to other fields of sociomedical expert opinion-building. The article describes requirements and difficulties in psychiatric disability assessment, the list of indicators and experiences gained from the process of development.
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