Horizontal return to work coordination was more common in RTW programs than the recommended vertical coordination. The Rapid-RTW cohort study

Abstract

BackgroundIn return-to-work (RTW) programs, coordinators are often provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration (i.e. between levels/institutions, or within one service/level). The aim of this study was therefore to explore and describe if and how a coordinator was provided in RTW-programs, and whether the provision of a coordinator was associated with certain personal or intervention characteristics.MethodsThe study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs in Norway (n = 39). Employees (n = 494) answered a self-administered questionnaire, which was linked to register-data on diagnoses and sickness-absence. Employees who replied yes/no to the question “Did the program provide a person who tailored or coordinated your services?” were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models.ResultsSixty-nine percent of the employees reported having a coordinator. These coordinators were mainly responsible for coordinating treatment within own programs (i.e. horizontal coordination, 68%). As expected, rehabilitation programs more often provided a coordinator compared to treatment programs (OR 3.87 95% CI 2.42–6.24). The odds for being provided with a coordinator were reduced for each additional year of age of the employee (OR 0.97, 95% CI 0.96–0.99). More professions were involved in programs that provided coordinators, also more contact with other stakeholders like leaders and social insurance services (NAV), but only contact with supervisor remained statistically significant in adjusted analysis (OR 1.69 95% CI 0.31–9.27). The programs with a coordinator more often provided adaptations at the workplace for the individual employee (OR 0.08 95% CI 0.01–0.60). However, these signs of vertical integration were only evident for a limited number of employees.ConclusionIn this study, seven of ten employees reported to have a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Most of these coordinators did not coordinate vertically between the service levels and types of intervention arenas for sick listed employees (i.e. workplace, social security, and health care services), as recommended in earlier research.

Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers

“…Challenges to the integration of RTW services between stakeholders are well documented in international [8,9] and Swedish research [10,11]. As a response to this, coordination of RTW is increasingly recognised and included in private initiatives or policy changes [12][13][14][15][16][17][18]. Coordination of RTW vary greatly in terms of the type of setting in which the coordinators are employed [12,15], the level of coordination (e.g.…”

“…Coordination of RTW vary greatly in terms of the type of setting in which the coordinators are employed [12,15], the level of coordination (e.g. across levels of systems and organizations, or within one level of a system or organization) [14,15]. Coordinators are employed by health care organisations, insurance companies, large organisations, or are self-employed [15,16,18] and the professional background and training of individuals employed as coordinators varies [15][16][17][18].…”

“…The implementation of coordinator services in Scandinavia is at an early stage of development, but is increasingly being implemented alongside policy changes [14,19,20]. In Sweden, coordinators are employed mainly in the primary care services.…”

Return-to-work: Exploring professionals’ experiences of support for persons with spinal cord injury

“…A majority of those with a traumatic SCI in Sweden are in working age [59], and coordination of RTW derived from the SCI rehabilitation setting has the potential of organising the early RTW process for them. The use of coordinators is increasingly reported [35][36][37][38][39][40], and coordination of RTW within healthcare is legally required in Sweden [30]. Yet, persons with SCI in Sweden typically lack coordinator availability, and the evidence for coordination of RTW is still uncertain [41,42].…”

“…These are: challenges to coordination [31]; divergent perspectives on work ability assessments [32,33]; fragmentation of the RTW process due to lack of routines [31,32]; and lack of knowledge about others' expertise and capacity for actions [31,34]. As a response to poor coordination of RTW, integration of services using a coordinator is being increasingly reported internationally [35][36][37][38][39] and is also described in Sweden [40]. The evidence for such services is still uncertain [41,42] and implementation strategies vary [41].…”