Sickness absence in musculoskeletal disorders - patients' experiences of interactions with the Social Insurance Agency and health care. A qualitative study

Abstract

BackgroundSickness absence has represented a growing public health problem in many Western countries over the last decade. In Sweden disorders of the musculoskeletal system cause approximately one third of all sick leave. The Social Insurance Agency (SIA) and the health care system are important actors in handling the sickness absence process. The objective was to study how patients with personal experience of sickness absence due to musculoskeletal disorders perceived their contact with these actors and what they considered as obstructing or facilitating factors for recovery and return to work in this situation.MethodsIn-depth interviews using open-ended questions were conducted with fifteen informants (aged 33-63, 11 women), all with experience of sickness absence due to musculoskeletal disorders and purposefully recruited to represent various backgrounds as regards diagnosis, length of sick leave and return to work. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis.ResultsThe informants' perceived the interaction with the SIA and health care as ranging from coherent to fragmented. Being on sick leave was described as going through a process of adjustment in both private and working life. This process of adjustment was interactive and included not only the possibilities to adjust work demands and living conditions but also personal and emotional adjustment. The informants' experiences of fragmented interaction reflected a sense that their entire situation was not being taken into account. Coherent interaction was described as facilitating recovery and return to work, while fragmented interaction was described as obstructing this. The complex division of responsibilities within the Swedish rehabilitation system may hamper sickness absentees' possibilities of taking responsibility for their own rehabilitation.ConclusionsThis study shows that people on sick leave considered the interaction with the SIA and health care as an important part of the rehabilitation process. The contact with these actors was perceived as affecting recovery and return to work. Working for a more coherent process of rehabilitation and offering professional guidance to patients on sick leave might have an empowering effect.

Evaluation of Self-Reported Work Ability and Usefulness of Interventions Among Sick-Listed Patients

“…The importance of providing work-related interventions and adaptation of work for sick-listed From a patient perspective, it appears that support and adjustment at the workplace is a facilitating prerequisite for RTW (19)(20)(21), and specific goals for each patient can benefit the RTW process (18,30,32). We found that adjustments to work tasks or the work environment were the most prevalent interventions at the workplace for both diagnostic groups.…”

“…There is some evidence that collaboration between the sick-listed patient, health care providers and the employer favours the rehabilitation process (10,(16)(17)(18). Patients consider their contact with the health care provider as an important part of their rehabilitation that affects recovery and return to work (RTW) (17,(19)(20)(21)(22).…”

Occupational Risk Factors for Shoulder Tendon Disorders 2015 Update

“…The worker is subject to the power imbalance with the system, prolonged claims and appeals processes, medical reports being used out of context, and a general lack of knowledge about rights. Claims can be manipulated by ignoring or contesting diagnoses, using confusing jargon and legalistic communication, slow payments to non-preferred physician to discourage treatment [86][87][88][89][90][91][92][93][94][95][96][97][98].…”

Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF

“…For example, a social insurance agent may focus on medico-legal conceptions of work ability while an employer is concerned about productivity and an employment agent may focus on employability on a competitive labour market while the patient is concerned about attending work, economic self-sufficiency and keeping a job despite periods of sick-leave [1,35,38]. If such perspectives are made explicit it is easier to help patients to interact optimally.…”