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Abstract :
[en] Introduction
In Belgium, sickness absence (SA) management implies complementary roles for family (FPs), social insurance (SIPs) and occupational physicians (OPs): FPs deliver sick notes, SIPs control SA benefits and OPs strive to adapt work environments to workers’ capacities. In practice however, there is little cooperation between the three physicians. This study aimed at identifying FP-OP-SIP cooperation channels in order to prevent long-term work disability.
Methods
The study involved two phases. (1) Using the nominal group technique, researchers from the three physician groups reached a consensus on 15 proposals to enhance inter-professional cooperation. (2) A Delphi study was conducted to validate these proposals: 61 experts representing professional groups of physicians (FP, SIP, OP), patients, government, employers and labor unions were asked to participate. A 18-items questionnaire (the 15 proposals + 3 open questions) was used in a 2-round Delphi study. Proposals were accepted if 80% of experts agreed.
Results
Participation rate was 77% in round 1 and 7 out of the 15 proposals were accepted. During round 2, participation rate was 94%; 2 of the remaining proposals reached agreement level. Public authorities were thus advised to invest in a) promotion of pre-return to work visit with the OP for sick-listed patients; b) a website with OPs contact data; c) joint guidelines for return to work guidance; d) joint training of the 3 physician groups; 5) safe electronic information exchange. Several proposals aiming at giving work-related information to FPs and SIPs did not reach agreement within the OPs expert group. OPs expressed concerns about their own workload and FPs or SIPs ability to understand and use those information.
Discussion
The need for inter-physician cooperation in disability management may exceed individual goodwill and should best be organised by public authorities. This study may be a first step in this process.