Coordinators in the return-to-work process: Mapping their work models.

PURPOSE: In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden. METHODS: A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models. RESULTS: Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry. CONCLUSION: The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.

Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors.

BACKGROUND: We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual). METHODS: Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses. RESULTS: In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively). CONCLUSIONS: Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.