Person-centered collaboration in the sick leave and rehabilitation process - in a primary care context

Abstract

Aim: This thesis focuses on chronic illness and long-term health-related impairments in work ability, with the overarching aim of expanding knowledge about the sick leave and rehabilitation process (SRP) to support primary healthcare patients in achieving a sustainable return to a meaningful and independent life, while taking their health into account. Methods: This thesis comprises five papers: Paper I reports on a pilot study (n=20) of the LEARN-to-COPE intervention, aimed at enhancing participants’ sense of coherence and health literacy to improve their work ability and health. Papers II-IV present three qualitative studies exploring the desired scope of a person-centered SRP (paper II), the gap between current and ideal SRP states (paper III), and recommended process improvements (paper IV) from the perspectives of frontline employees across various stakeholder organizations. Finally, paper V describes a cluster randomized controlled trial (n=243) evaluating the LEARN-to-COPE intervention's impact on sick leave and health outcomes. Results: The pilot study recommended to continue with a randomized controlled trial to further study the effectiveness of the LEARN-to-COPE intervention. The qualitative studies showed frontline employees perceived 1) a need to extend the scope of SRP, 2) a large gap between the current and desired ways of working in the SRP, and 3) an opportunity to bridge the gap by coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The randomized controlled trial showed no effect of the LEARN-to-COPE intervention on scheduled activities or sick leave, but a positive effect on secondary outcomes health literacy and self-efficacy. Conclusion: This thesis suggests that the success of the SRP depends on how effectively it addresses both medical and non-medical challenges faced by patients. While patients' coping abilities influence outcomes, improving coping alone was found to be insufficient. Persistent quality issues within the SRP were identified as risks that could worsen patients' health, increase healthcare utilization, and extend the duration of sick leave. This thesis recommends that future research focus on enhancing the quality of the SRP process and implementing person-centered priorities at all levels. The findings from the SRP case are considered applicable to broader person-centered primary healthcare.