Does enhanced information exchange between social insurance physicians and occupational physicians improve patient work resumption? A controlled intervention study

Abstract

Background: Patient work resumption after sickness absence varies even among patients with similar pathologies and characteristics. Explanations remain uncertain. One newly investigated field is ''information asymmetry'', a situation in which critical information is not appropriately exchanged between stakeholders in disability management. It is hypothesised that information asymmetry between social insurance physicians and occupational physicians prolongs sickness absence. Objectives: To assess the influence of enhanced information exchange between these physicians on patient outcome. Methods: Non-randomised controlled intervention study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. Inclusion criteria were: employee, age 18-50, and subacute (more than one month) sickness absence. The intervention was a structured information exchange (through the use of a communication form) between the patient's social insurance physician and occupational physician. The intervention started when the patient's sickness absence reached the subacute stage, and ended when the sickness absence benefit was ceased or the duration exceeded one year. The primary outcome measure was the sickness absence benefit status of the patient assessed one year after benefit onset. Results: Of the 1883 patients asked to enrol in the study, 1564 (84%) participated; 505 (32%) of 1564 patients were assigned to the intervention group and 1059 (68%) to the control group; 1553 (99%) of 1564 patients completed the study. In the intervention group, 86% received no sickness absence benefit at the end of the study, versus 84% in the control group (95% CI 0.91-1.15). No significant differences in other outcome parameters were obtained. Conclusions: Information exchange between physicians may not be enough to influence work resumption among patients on sickness absence. Further research on stakeholders' information asymmetry and its effect on the outcome of patients are necessary. The complexity of information asymmetry in disability management cannot be underestimated.

The development of instruments to measure the work disability assessment behaviour of insurance physicians

“…Deciding whether or not to request and use information of third parties may influence the assessment, and this is done to a very varied extent [ 62 , 67 , 68 ]. Davis et al [ 69 ] found that diagnostic uncertainty among GPs was associated with higher rates of investigation and follow-up.…”

Patientenversorgung an der Schnittstelle von Rehabilitation und Betriebsärzten

“…Alle Akteure des Rehabilitationsprozesses sind von der Dringlichkeit einer zeitnahen, reibungslosen Kommunikation und Kooperation überzeugt [7,21,24,29,33,35,[43][44]55]. Es existieren jedoch multiple Hinweise für eine unbefriedigende Kooperation und Kommunikation zwischen Rehabilitationskliniken und Betriebsärzten sowie für mangelnde Kenntnisse bei anderen Facharztrichtungen hinsichtlich betriebsärztlichen Aufgaben und Kompetenzen [8,9].…”

Associations Between Schemes of Social Insurance and Self-Rated Health Comparison: Evidence From the Employed Migrants in Urban China

“…This was congruent with several studies that attached importance to social insurance officers (36, 37). Individual health improvement of the insured workers might also be negatively affected by information exchange with social insurance physicians and occupational physicians (38), insurance underutilization (39), poor personal contact with social insurance officers and health care professionals (40), and low use of evidence-based medicine and clinical practice guidelines in insurance medicine (41). Another study showed that the interaction with the social insurance agency and health care could be considered as an important part of the rehabilitation process (42).…”