Determinants of return to work after long-term sickness absence in six Danish municipalities

Stoltenberg, Christian; Skov, Peder

doi:10.1177/1403494809357095

Cited by 21 publications

(27 citation statements)

References 16 publications

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“…Complex interventions, which include several interacting active ingredients, are particularly prone to reinvention and implementation failure (17)(18)(19), and the large differences in intervention effect between the three municipalities may therefore not be surprising. In agreement with the present study, it has been previously shown that RTW for sick-listed beneficiaries from six different Danish municipalities varied substantially -even after controlling for diagnosis, income, education, and age (20). The authors suggested that these differences might be attributed to variations in the sickness absence management or the skills and attitudes of the social insurance officers.…”

Section: Discussionsupporting

confidence: 78%

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities

Poulsen¹,

Aust²,

Bjørner³

et al. 2013

Scand J Work Environ Health

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This is the largest RCT ever conducted on effects of a multiple component return-to-work intervention (coordinated, tailored, and multidisciplinary). The effects of the intervention on duration of sickness absence were remarkably different between the three municipalities examined indicating that contextual factors are of major importance for success or failure of this complex intervention. 47Original article Scand J Work Environ Health. 2014;40(1):47-56. doi:10.5271/sjweh.3383 Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities Objectives The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities. MethodsThe intervention group comprised 1948 participants while the control group comprised 1157 participants receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status. Each beneficiary was followed-up for a maximum period of 52 weeks. Cox proportional hazards model was used to estimate hazard ratios (HR) for return to work (RTW) with 95% confidence intervals (95% CI). ResultsThe intervention effect differed significantly between the municipalities (P=0.00005). In one municipality (M2) the intervention resulted in a statistically significant increased rate of recovery from long-term sickness absence (HR 1.51, 95% CI 1.31-1.74). In the other two municipalities, the intervention did not show a statistically significant effect (HR M1 1.12, 95% CI 0.97-1.29, and HR M3 0.80, 95% CI 0.63-1.03, respectively). Adjustment for a series of possible confounders only marginally altered the estimated HR. ConclusionThe effect of the intervention differed substantially between the three municipalities, indicating that that contextual factors are of major importance for success or failure of this complex intervention.Key terms coordinated case management; Denmark; effect evaluation; intervention; multidisciplinary; RTW; work resumption. In 2008, the annual level of sickness absence in Denmark corresponded to approximately 5% of the workforce, and reimbursement costs per year were estimated to be around €5 billion (approximately €1350 per capita age 18-64 years) not including treatment costs or loss of productivity (1). Promoting labor market participation is essential for Denmark and other European countries facing a decline in the proportion of people of working age due to an aging workforce (2). To reduce sickness absence and improve labor market participation, the Danish Government launched an action plan in 2008 encompassing 39 initiatives including the Danish returnto-work (RTW) program. The Danish National Research Centre for the Working Environment (NRCWE) was appointed to develop the program in accordance with the action plan, existing sickness management leg...

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Section: Discussionsupporting

confidence: 78%

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities

Poulsen¹,

Aust²,

Bjørner³

et al. 2013

Scand J Work Environ Health

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“…Trygged et al found an association between educational level and RTW (6). A Danish study of the association between education and RTW after long-term periods of sick leave (of all causes) came to the same conclusion (35). Educational level was not associated with RTW in this study.…”

Section: Discussionsupporting

confidence: 68%

Self-rated health and return to work after first-time stroke

Larsen¹,

Biering²,

Johnsen³

et al. 2016

J Rehabil Med

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Objective: Self-rated health is an essential aspect of life after stroke, and return to work is considered one of the most important outcomes for younger stroke patients. The aim of this study was to examine whether self-rated health 3 months after stroke, clinical and demographic determinants are independently associated with return to work and subsequent work-stability. Material and methods: A total of 590 patients with firsttime stroke were included from a Danish population-based cohort study. All patients were younger than 60 years and working or unemployed at the time of stroke. Information on self-rated health (Short Form 12; SF-12) was collected from questionnaires 3 months after stroke. Employment status was defined on a weekly basis using national registerdata on transfer payments. Results: Fifty percent were self-supporting or job-seeking 12 months after stroke, and the same proportion was found after 24 months. More than 70% of the patients who returned to work did not receive sickness benefits in the 12 months following return to work. Good self-rated health 3 months after stroke and minor stroke severity were strongly associated with return to work after 12 and 24 months. Conclusion: Self-rated health 3 months after stroke was strongly associated with return to work and work-stability after stroke.

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“…In sum, our data indicate that OSBM varies between municipalities. This finding is in line with previous studies of OSBM in Danish municipalities [37, 38]. Our findings also suggest that most municipalities constantly try to develop their OSBM.…”

Section: Resultssupporting

confidence: 93%

Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities

2017

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BackgroundThe aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support.MethodsWe used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI).ResultsWe found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97–1.07) or the duration until self-support (HR 0.99, CI 0.96–1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93–1.00) to 1.13 (CI 1.08–1.18) and self-support HRs ranging from 0.91 (CI 0.82–1.00) to 1.11 (CI 1.06–1.17).ConclusionsCompared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4236-5) contains supplementary material, which is available to authorized users.

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Determinants of return to work after long-term sickness absence in six Danish municipalities

Abstract: RTW increased during the first 1.5 years after which a steady level was maintained. The effect of diagnosis, age, and municipality changed markedly over time.

Cited by 21 publications

References 16 publications

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities

Self-rated health and return to work after first-time stroke

Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities

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