Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Study Setting
2.2. Data Collection and Research Population
2.3. Analysis
2.4. Reflexivity
3. Results
3.1. Attitudes toward the Other Health Care Service Sector
3.1.1. Knowledge about the Other Health Care Service Sector
Oh well, the thing that I think is the most central is that work ability would even be remembered. I think that it would be the most relevant point.—I don’t think that it is that difficult since the assessment of work ability is such a basic procedure for a physician, if they only think about it.(OHS, Occupational health physician, City 2)
When the patient calls the public primary health care center, the patient is instantly told to visit OHS, and if the issue requires medical care, the OHS contract may not cover it.(OHS, Occupational nurse, City 2)
And since occupational health care is such a complicated system and it is so different, depending on the current contract you may be unable to check anything, and there is no clear guidance for it.(Public primary health care, Physician, City 2)
3.1.2. Trust in the Other Stakeholder’s Services
Then, well, I don’t really know if public primary health care has anything to offer really at the moment, so yes, the process works well when the control is in our own hands and the process can be run through our own house, which is quite logical, since you know your own services, but right away when we go to the other side of the sector line (public primary health care), the picture gets blurry in every direction. It doesn’t really mean that the services there are bad, but I don’t really know them.(OHS, Occupational health physician, City 2)
3.2. Exchange of Information
3.2.1. Information Exchange Conventions
I don’t necessarily see even the texts written by occupational health care, what has already been done, the care paths are not clear and the patients don’t know who to contact or address their problem to.(Public primary health care, Physician, City 2)
I think we have a paper somewhere that has all the phone numbers… (searches the desk) I’m looking through the lists in my room to see whether there is a number to occupational health care anywhere... I don’t see it in the lists that are available to me here.(Physician, Public primary health care, City 3)
I have a habit of asking for permission from the patient and we may call straight to the nurse specialized in drug abuse (located in public primary health care) for example, so I tell the nurse that the patient is with me in the same room and ask if it would be possible to get some support for the patient, or we may call even to the adult counseling center (located in public primary health care).(OHS, Occupational nurse, City 2)
3.2.2. Need for Changes in Cooperation
I think that they (OHS) have high expertise in these matters and sharing of that knowledge would be beneficial overall.—It would also enhance the service structure.(Public primary health care, Physician, City 3)
It’s just, if we think of work ability issues, they aren’t solved at the physician’s visit, rather it requires multiprofessional expertise and often cooperation between occupational health care and special health care.—It is more preferrable to schedule a multiprofessional meeting, where the focus is the patient, and this is more efficient for every participating party.(Public primary health care, Physician, City 1)
Sometimes it is more essential that there remains some kind of border or limit between the sectors to remember that public primary care and occupational health care are separate operators, even though the same private service provider is providing both of the services.(OHS, Occupational health physician, City 2)
And even though we are in the same building and even though we meet occupational physicians, for example, in the canteen where we have lunch, we don’t agree or discuss shared patients.(Public primary health care, Physician, City 3)
3.3. Resources for Cooperation
Feelings of Insufficiency
Since we have not received any time for the paperwork, I do it all within the one hour: I define the status, I investigate the background and make a care plan and maybe some sickness statements. All this within the one-hour appointment, since we don’t have time to do this, thus I don’t have any time to make any phone calls within that time. The time is limited.(Public primary health care, Physician, City 3)
And the physicians change in the public primary health care centers; you can’t keep track of those who are currently working in the health care center. Previously you could know exactly that there were those permanent physicians. The people change and are replaced so often that it also bothers the cooperation and advancement of the cooperation.(OHS, Occupational nurse, City 2)
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- WHO/ILO. Joint Estimates of the Work-Related Burden of Disease and Injury, 2000–2016; WHO/ILO: Geneva, Switzerland, 2021. Available online: https://www.who.int/publications/i/item/9789240034945 (accessed on 29 June 2022).
- Tompa, E.; Mofidi, A.; van den Heuvel, S.; van Bree, T.; Michaelsen, F.; Jung, Y.; Porsch, L.; van Emmerik, M. The Value of Occupational Safety and Health and the Societal Costs of Work-Related Injuries and Diseases; European Agency for Safety and Health at Work (EU-OSHA): Luxembourg, 2019; Available online: https://osha.europa.eu/en/publications/value-occupational-safety-and-health-and-societal-costs-work-related-injuries-and (accessed on 29 June 2022).
- Rissanen, M.; Kaseva, E. Menetetyn Työpanoksen Kustannus; Ministry of Social Affairs and Health: Helsinki, Finland, 2014; Available online: https://valtioneuvosto.fi/en/-/1271139/mika-on-menetetyn-tyopanoksen-hinta- (accessed on 29 June 2022).
- Takala, E.-P.; Leino, T.; Hirvonen, M.; Kauranen, T.; Liljeström, K.; Syynimaa, S.; Österbacka, O. Työterveyshuollon Toiminta Ja Laatu Suomessa 2018; Finnish Institute of Occupational Health: Helsinki, Finland, 2019; Available online: https://www.julkari.fi/handle/10024/138566 (accessed on 29 June 2022).
- Jolanki, O.; Tynkkynen, L.-K.K.; Sinervo, T. Professionals’ Views on Integrated Care. J. Integr. Care 2017, 25, 247–255. [Google Scholar] [CrossRef]
- Beyer, S.; Gouyet, T.; Letourneux, V.D.; Mener, E.; Huge, S.; Petit, A.; Begue, C. Interprofessional Communication Concerning Work-Related Musculoskeletal Disorders: A Qualitative Study. J. Occup. Rehabil. 2018, 28, 721–729. [Google Scholar] [CrossRef]
- Liukko, J.; Kuuva, N. Toimijoiden Yhteistyö Työkykyongelmien Hallinnassa—Ammattilaisten Haastatteluihin Perustuva Tutkimus; 03/2015 Eläketurvakeskuksen Raportteja; Eläketurvakeskus: Helsinki, Finland, 2015; Available online: https://www.julkari.fi/handle/10024/129017 (accessed on 29 June 2022).
- Lundin, A.; Kjellberg, K.; Leijon, O.; Punnett, L.; Hemmingsson, T. The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence, Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study. J. Occup. Rehabil. 2016, 26, 195–203. [Google Scholar] [CrossRef] [PubMed]
- Beaumont, D.G. The Interaction between General Practitioners and Occupational Health Professionals in Relation to Rehabilitation for Work: A Delphi Study. Occup. Med. 2003, 53, 249–253. [Google Scholar] [CrossRef] [PubMed]
- Moßhammer, D.; Michaelis, M.; Mehne, J.; Wilm, S.; Rieger, M.A. General Practitioners’ and Occupational Health Physicians’ Views on Their Cooperation: A Cross-Sectional Postal Survey. Int. Arch. Occup. Environ. Health 2016, 89, 449–459. [Google Scholar] [CrossRef] [PubMed]
- Stratil, J.M.; Rieger, M.A.; Vöelter-Mahlknecht, S. Image and Perception of Physicians as Barriers to Inter-Disciplinary Cooperation?—The Example of German Occupational Health Physicians in the Rehabilitation Process: A Qualitative Study. BMC Health Serv. Res. 2018, 18, 769. [Google Scholar] [CrossRef]
- Viikari-Juntura, E.; Leinonen, T.; Virta, L.J.; Hiljanen, I.; Husgafvel-Pursiainen, K.; Autti-Rämo, I.; Rissanen, P.; Burdorf, A.; Solovieva, S. Early Part-Time Sick Leave Results in Considerable Savings in Social Security Costs at National Level: An Analysis Based on a Quasi-Experiment in Finland. Scand. J. Work. Environ. Health 2019, 45, 203–208. [Google Scholar] [CrossRef]
- Vanmeerbeek, M.; Govers, P.; Schippers, N.; Rieppi, S.; Mortelmans, K.; Mairiaux, P. Searching for Consensus among Physicians Involved in the Management of Sick-Listed Workers in the Belgian Health Care Sector: A Qualitative Study among Practitioners and Stakeholders Global Health. BMC Public Health 2016, 16, 164. [Google Scholar] [CrossRef]
- Beaumont, D.G. Rehabilitation and Retention in the Workplace—The Interaction between General Practitioners and Occupational Health Professionals: A Consensus Statement. Occup. Med. 2003, 53, 254–255. [Google Scholar] [CrossRef]
- Verger, P.; Ménard, C.; Richard, J.-B.B.; Demortière, G.; Beck, F. Collaboration between General Practitioners and Occupational Physicians: A Comparison of the Results of Two National Surveys in France. J. Occup. Environ. Med. 2014, 56, 209–213. [Google Scholar] [CrossRef]
- Finlex 1383/2001 Occupational Health Care Act. Available online: https://www.finlex.fi/en/laki/kaannokset/2001/en20011383 (accessed on 11 June 2022).
- Reho, T.T.M.; Atkins, S.; Korhonen, M.; Siukola, A.; Sumanen, M.; Viljamaa, M.; Uitti, J.; Sauni, R. Parallel Use of Primary and Secondary Healthcare by Frequent Attenders in Occupational Health and Their Work Disability: A Longitudinal Study in Finland. BMJ Open 2022, 12, e052740. [Google Scholar] [CrossRef] [PubMed]
- Liukko, J.; Kuuva, N. Cooperation of Return-to-Work Professionals: The Challenges of Multi-Actor Work Disability Management. Disabil. Rehabil. 2017, 39, 1466–1473. [Google Scholar] [CrossRef] [PubMed]
- Nilsing, E.; Söderberg, E.; Berterö, C.; Öberg, B. Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden. J. Occup. Rehabil. 2013, 23, 450–461. [Google Scholar] [CrossRef] [PubMed]
- Foley, M.; Thorley, K.; Van Hout, M.C. Assessing Fitness for Work: GPs Judgment Making. Eur. J. Gen. Pract. 2013, 19, 230–236. [Google Scholar] [CrossRef] [PubMed]
- Nordling, P.; Priebe, G.; Björkelund, C.; Hensing, G. Assessing Work Capacity—Reviewing the What and How of Physicians’ Clinical Practice. BMC Fam. Pract. 2020, 21, 72. [Google Scholar] [CrossRef] [PubMed]
- Ståhl, C.; Svensson, T.; Petersson, G.; Ekberg, K. The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams. J. Occup. Rehabil. 2009, 19, 264–273. [Google Scholar] [CrossRef]
- Neubauer, B.E.; Witkop, C.T.; Varpio, L. How Phenomenology Can Help Us Learn from the Experiences of Others. Perspect. Med. Educ. 2019, 8, 90–97. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using Thematic Analysis in Psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Ho, K.; Chiang, V.; Leung, D. Hermeneutic Phenomenological Analysis: The ‘Possibility’ beyond ‘Actuality’ in Thematic Analysis. J. Adv. Nurs. 2017, 73, 1757–1766. [Google Scholar] [CrossRef]
- Heidegger, M.; Stambaugh, J.; Schmidt, D. Being and Time; State University of New York Press: Albany, NY, USA, 2010; pp. 1–482. [Google Scholar]
- Palinkas, L.A.; Horwitz, S.M.; Green, C.A.; Wisdom, J.P.; Duan, N.; Hoagwood, K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm. Policy Ment. Health 2015, 42, 533–544. [Google Scholar] [CrossRef] [Green Version]
- Malterud, K.; Siersma, V.D.; Guassora, A.D. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual. Health Res. 2016, 26, 1753–1760. [Google Scholar] [CrossRef] [PubMed]
- Gutting, G. Continental Philosophy of Science, 1st ed.; Blackwell Publishing: Hoboken, NJ, USA, 2005; p. 345. [Google Scholar]
- Loisel, P.; Durand, M.J.; Baril, R.; Gervais, J.; Falardeau, M. Interorganizational Collaboration in Occupational Rehabilitation: Perceptions of an Interdisciplinary Rehabilitation Team. J. Occup. Rehabil. 2005, 15, 581–590. [Google Scholar] [CrossRef] [PubMed]
- Hujala, A.; Lammintakanen, J. Paljon Sote-Palveluja Tarvitsevat Ihmiset Keskiöön; Kunnallisalan Kehittämissäätiön Julkaisu 12/2018; Kunnallisalan Kehittämissäätiö: Helsinki, Finland, 2018; Available online: https://kaks.fi/julkaisut/paljon-sote-palveluja-tarvitsevat-ihmiset-keskioon/ (accessed on 29 June 2022).
- Stratil, J.M.; Rieger, M.A.; Völter-Mahlknecht, S. Cooperation between General Practitioners, Occupational Health Physicians, and Rehabilitation Physicians in Germany: What Are Problems and Barriers to Cooperation? A Qualitative Study. Int. Arch. Occup. Environ. Health 2017, 90, 481–490. [Google Scholar] [CrossRef]
- Nauta, N.; Weel, A.; Overzier, P.; von Grumbkow, J. The Effects of a Joint Vocational Training Programme for General Practitioner and Occupational Health Trainees. Med. Educ. 2006, 40, 980–986. [Google Scholar] [CrossRef] [PubMed]
- Buijs, P.C.; Weel, A.N.H.H.; Nauta, N.P.; Anema, H.R.; Schoonheim, P.L.; Helsloot, R.S.M.M. Teaching General Practitioners and Occupational Physicians to Cooperate: Joint Training to Provide Better Care for European Workers. Eur. J. Gen. Pract. 2009, 15, 125–127. [Google Scholar] [CrossRef]
- Auschra, C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int. J. Integr. Care 2018, 18, 5. [Google Scholar] [CrossRef]
- Hassard, J.; Jain, A.; Leka, S. International Comparison of Occupational Health Systems and Provisions, A Comparative Case Study Review; Department for Work & Pensions: London, UK, 2021. Available online: https://www.gov.uk/government/publications/international-comparison-of-occupational-health-systems-and-provisions (accessed on 25 July 2022).
- Council of the European Union, A New EU Strategic Framework on Health and Safety at Work—Enhancing the Implementation of Occupational Safety and Health in the EU (5.12.2019). Available online: https://www.consilium.europa.eu/en/press/press-releases/2019/12/10/improving-health-and-safety-at-work-the-council-adopts-conclusions/ (accessed on 25 July 2022).
- Aira, M.; Mäntyselkä, P.; Vehviläinen, A.; Kumpusalo, E. Occupational Isolation among General Practitioners in Finland. Occup. Med. 2010, 60, 430–435. [Google Scholar] [CrossRef]
- Stern, A.F.; Madan, I. Optimal Communication from Occupational Physicians to GPs: A Cross-Sectional Survey. Br. J. Gen. Pract. J. R. Coll. Gen. Pract. 2012, 62, 834–839. [Google Scholar] [CrossRef]
- de Bono, A.M. Communication between an Occupational Physician and Other Medical Practitioners--an Audit. Occup. Med. 1997, 47, 349–356. [Google Scholar] [CrossRef]
- Finlex 1050/2018 Data Protection Act. Available online: https://www.finlex.fi/en/laki/kaannokset/2018/20181050 (accessed on 10 June 2022).
- Kneck, Å.; Flink, M.; Frykholm, O.; Kirsebom, M.; Ekstedt, M. The Information Flow in a Healthcare Organisation with Integrated Units. Int. J. Integr. Care 2019, 20, 20. [Google Scholar] [CrossRef] [Green Version]
- Junnila, M.; Fredriksson, S. Palvelujen Ulkoistus; Finnish Institute for Health and Welfare: Helsinki, Finland, 2012; Available online: https://www.julkari.fi/handle/10024/90876 (accessed on 29 June 2022).
- Couffinhal, A.; Cylus, J.; Elovainio, R.; Figueras, J.; Jeurissen, P.; Mckee, M.; Smith, P.; Thomson, S.; Winblad, U. International Expert Panel Pre-Review of Health and Social Care Reform in Finland. In Reports and Memorandums of the Ministry of Social Affairs and Health; The Ministry of Social Affairs and Health: Helsinki, Finland, 2016; Volume 66, Available online: https://julkaisut.valtioneuvosto.fi/handle/10024/79070 (accessed on 29 June 2022).
- Kyngäs, H.; Kääriäinen, M.; Elo, S. The Trustworthiness of Content Analysis. In The Application of Content Analysis in Nursing Science Research; Kyngäs, H., Mikkonen, K., Kääriäinen, M., Eds.; Springer Publishing: Cham, Switzerland, 2020; pp. 41–48. [Google Scholar]
Interview | Interview Location | Interview Length (min) | City | Organization | Number of Interviewees | Profession | Gender |
---|---|---|---|---|---|---|---|
1 | MS Teams | 26 | 1 | Public primary health care 1 | 1 | GP | M |
2 | MS Teams | 35 | 1 | Public primary health care 1 | 1 | GP | M |
3 | MS Teams | 25 | 1 | Public primary health care 1 | 1 | GP | F |
4 | Meeting room | 42 | 1 | Public primary health care 1 | 3 * | Nurse | F |
5 | MS Teams | 29 | 1 | Public primary health care 1 | 1 | GP | F |
6 | MS Teams | 20 | 2 | Public primary health care 2 | 1 | GP | M |
7 | MS Teams | 24 | 2 | Public primary health care 2 | 1 | GP | F |
8 | MS Teams | 31 | 2 | Public primary health care 2 | 1 | GP | M |
9 | MS Teams | 37 | 2 | Public primary health care 2 | 4 * | Nurse | F |
10 | MS Teams | 28 | 2 | Public primary health care 2 | 1 | GP | M |
11 | MS Teams | 37 | 1 | OHS 3 | 2 * | Occupational nurse | F |
12 | MS Teams | 48 | 2 | OHS 4 | 2 * | Occupational nurse | F |
13 | MS Teams | 31 | 2 | OHS 4 | 1 | Occupational health physicians | M |
14 | MS Teams | 26 | 3 | Public primary health care 5 | 2 * | Nurse | F |
15 | MS Teams | 36 | 3 | Public primary health care 5 | 1 | GP | F |
16 | MS Teams | 21 | 3 | Public primary health care 5 | 1 | GP | M |
17 | MS Teams | 30 | 3 | Public primary health care 5 | 1 | Chief physician | F |
18 | MS Teams | 34 | 4 | Public primary health care 6 | 1 | Nurse | F |
19 | MS Teams | 40 | 3 | Public primary health care 5 | 1 | GP | M |
20 | MS Teams | 60 | 5 | Public primary health care 7 | 2 * | Nurse | F |
Data Extract | Code | Sub Theme | Theme | Topic |
---|---|---|---|---|
Lack of connection and phone call: I think we have a paper somewhere that has all the phone numbers… (searches the desk) I’m looking through the lists in my room to see whether there is a number to occupational health care anywhere... I don’t see it in the lists that are available to me here. | Communication | Information exchange conventions | Exchange of information | Cooperation between public primary health care and occupational health care on issues related to patient’s work ability |
Transition: When you talk with one, the next you hear is that he or she is not working there anymore. Even our chief physician has changed. | Transition | Feeling of insufficiency | Resources for cooperation | Cooperation between public primary health care and occupational health care on issues related to patient’s work ability |
Length of reception: But the situations can come as a surprise, a fifteen-minute appointment may have been scheduled for the patient, which is really a short time,—sometimes you may have to say that we need more time for example for tomorrow, so that we can really try to solve the situation as a whole. | Hurry | Feeling of insufficiency | Resources for cooperation | Cooperation between public primary health care and occupational health care on issues related to patient’s work ability |
Topic | ||||
Cooperation between public primary health care and occupational health care on issues related to patient’s work ability | ||||
Themes | ||||
Attitudes toward the other health care service sector | Exchange of information | Resources for cooperation | ||
Sub Themes | Sub Themes | Sub Themes | ||
Knowledge about the other health care service | Trust in the other stakeholder’s services | Information exchange conventions | Need for changes in cooperation | Feeling of insufficiency |
Codes | Codes | Codes | ||
Knowledge (Unclear + Uncertainty + Unsure) | Trust (Service quality + Trust) | Patient lost in the system Law (Text availability + Missing information + Privacy policy) Patient’s responsibility Communication (Phone call + Direct contact + Direct connection + Making connection + Way of making connection + Information transfer + Information exchange + Communication + A good information exchange) | Reduction of cooperation (Decline of cooperation + Change of cooperation + Weakening cooperation) Multiprofessional need (Network meeting + Multiprofessional + Multiprofessional need + Multiprofessional requirement + Multiprofessional assessment + Multiple stakeholders) Same service provider (Same service provider + Defining responsibilities) | Hurry (Resources + Hurry) Physical proximity Transition (Change of employment + Reason (transition) + Transition) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Vähätalo, L.; Siukola, A.; Atkins, S.; Reho, T.; Sumanen, M.; Viljamaa, M.; Sauni, R. Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues. Int. J. Environ. Res. Public Health 2022, 19, 11916. https://doi.org/10.3390/ijerph191911916
Vähätalo L, Siukola A, Atkins S, Reho T, Sumanen M, Viljamaa M, Sauni R. Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues. International Journal of Environmental Research and Public Health. 2022; 19(19):11916. https://doi.org/10.3390/ijerph191911916
Chicago/Turabian StyleVähätalo, Lauri, Anna Siukola, Salla Atkins, Tiia Reho, Markku Sumanen, Mervi Viljamaa, and Riitta Sauni. 2022. "Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues" International Journal of Environmental Research and Public Health 19, no. 19: 11916. https://doi.org/10.3390/ijerph191911916
APA StyleVähätalo, L., Siukola, A., Atkins, S., Reho, T., Sumanen, M., Viljamaa, M., & Sauni, R. (2022). Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues. International Journal of Environmental Research and Public Health, 19(19), 11916. https://doi.org/10.3390/ijerph191911916