Työeläkekuntoutuksen vaikuttavuuden kehittäminen ja työkykyajattelu

Artikkelissa tarkastellaan työeläkelaitosten rahoittaman ammatillisen kuntoutuksen eli työeläkekuntoutuksen toimivuutta ja kehittämistä työeläkelaitosten asiantuntijoiden haastatteluiden perusteella. Viimeaikaiset tutkimustulokset työeläkekuntoutuksen vaikuttavuudesta ovat herättäneet keskustelua erityisesti työpaikalla tapahtuvien lyhytaikaisten toimien kustannustehokkuudesta. Tätä taustaa vasten artikkelin painopiste on asiantuntijoiden esiin nostamissa kehittämisajatuksissa. Aineisto muodostuu työeläkelaitosten kuntoutusasiantuntijoiden ja vakuutuslääkärien haastatteluista. Aineisto sisältää kuusi laajaa haastattelua, joissa oli yhteensä 15 haastateltavaa. Menetelmänä käytetään temaattista sisällönanalyysia. Tutkimuksen teoreettinen viitekehys muodostuu erilaisista työkyvyn edistämisen malleista. Keskeisenä kehittämisen kohteena haastatteluissa pidettiin ensinnäkin panostamista työn muokkaamiseen työkokeilujen aikana ja erilaisiin jatkotoimenpiteisiin niiden jälkeen. Toiseksi työkokeiluja pidempiaikaisemmat kuntoutustoimenpiteet,kuten työhönvalmennus ja koulutus, nähtiin usein järkeviksi vaihtoehdoiksi kestävien työllisyysvaikutusten näkökulmasta. Kolmanneksi kuntoutuksen työllisyysvaikutuksia saattaisi haastattelujen perusteella parantaa erityisesti työeläkejärjestelmän, Kelan ja työvoimapalvelujen yhteistyön tiivistäminen. Artikkeli osoittaa, minkälaisiin työkyvyn edistämisen malleihin haastateltavien esittämät kehittämisideat kytkeytyvät. Abstract Improving the effectiveness of vocational rehabilitation under the earnings-related pension scheme and the concept of work ability. Study based on interviews with experts from earnings-related pension providersIn this interview-based article we examine the effectiveness of vocational rehabilitation financed by earnings-related pension providers and its development. Recent studies on the efficiency of vocational rehabilitation have raised discussions particularly on the cost-efficiency of short-term rehabilitation at the workplace. The focal area of this article is thus on the development ideas presented by the experts. The data is based on interviews with rehabilitation experts at earnings-related pension providers and insurance physicians. The dataset consists of six extensive interviews with a total of 15 interviewees. The data is analysed using thematic content analysis. The theoretical framework of the study consists of various models of work ability. As key areas that require improvement the interviewees pointed out adjusting work tasks during work try-outs and taking various further actions after completing work try-outs. Second, longer-lasting rehabilitation measures, such as job coaching and training, were increasingly seen as viable options to achieve sustainable employment effects. Thirdly, based on the interviews, the employment effects of vocational rehabilitation may be improved through, in particular, closer co-operation between the earnings-related pension system, Kela and employment services. The article shows which types of models of work ability the development ideas of the experts are connected to. Key words: vocational rehabilitation, work ability, effectiveness, co-operation, experts, interview study

Determinants for the implementation of person-centered tools for workers with chronic health conditions: a mixed-method study using the Tailored Implementation for Chronic Diseases checklist

Background The aim was to identify the most important determinants of practice for the implementation of person-centered tools which enhance work participation for patients with chronic health conditions. Methods A mixed-method study was conducted consisting of semi-structured interviews, a focus group and a survey. Various stakeholders were involved including (representatives of) workers with chronic health conditions, insurance physicians, occupational physicians, other healthcare professionals, researchers, employers, and policymakers. The semi-structured interviews were performed to identify implementation determinants, followed by a focus group to validate resulting determinants. To conclude, a survey was conducted to select the most important implementation determinants through prioritization by ranking the order of importance. The Tailored Implementation of Chronic Diseases checklist (TICD) was used as concept-driven coding frame for the qualitative analysis of the interviews and focus group. The self-developed survey was based on the domains of the TICD. The survey was analyzed by frequency count of first ranking of determinants per and between domains of the TICD. Results Various stakeholders participated (N = 27) in the interviews and focus group. The qualitative data retrieved yielded a list of determinants with additional in-depth themes according to the TICD. For the selection of the most important determinants, a survey with 101 respondents was conducted, consisting of occupational physicians, insurance physicians and workers with a chronic health condition. From the seven domains of the TICD, respondents emphasized the importance of taking into account the needs and factors associated with workers with a chronic health condition as this determinant ranked highest. Taking into account the individual needs and wishes of workers was mentioned to enable successful implementation, whereas stress of the workers was indicated to impede implementation. Other important determinants included ‘being able to work with the tools’ in terms of time and usability or ‘cognitions, beliefs and attitudes of occupational and insurance physicians’ to be able to use the tools. Conclusion This study identified the most important determinants from the perspective of various stakeholders involved in the implementation of client-centered tools in occupational health for workers with chronic health conditions. Furthermore, by prioritizing the most important determinants, targeted implementation strategies can be developed.

Beliefs and practices among primary care physicians during the first wave of the COVID-19 pandemic in Baden-Wuerttemberg (Germany): an observational study

Background During the first wave of the COVID-19 pandemic various ambulatory health care models (SARS-CoV-2 contact points) were organised in a short period in Baden-Wuerttemberg, a region in Southern Germany. The aim of these SARS-CoV-2 contact points was to ensure medical treatment for patients with (suspected) and without SARS-CoV-2 infection. The present study aimed to assess the beliefs and practices of primary care physicians who either led a SARS-CoV-2 contact point or a primary care practice in Baden-Wuerttemberg during the first wave of the COVID-19 pandemic.Methods This cross-sectional study was based on a paper-based questionnaire in primary care physicians during the first wave of the pandemic. Participants were identified via the web page of the Association of Statutory Health Insurance Physicians Baden-Wuerttemberg. The questionnaire was distributed between June and July 2020. It measured knowledge, practices, self-efficacy and fears towards SARS-CoV-2, using newly developed questions. Data was descriptively analysed.Results 155 participants (92 leads of SARS-CoV-2 contact points/ 63 leads of primary care practices) completed the questionnaire. About half participants of both groups did not fear an own infection with the novel virus (between 50.8% and 65.2%), however about 75 % feared financial loss. Knowledge was gained using various sources; main sources were the Association of Statutory Health Insurance Physicians (between 79.3% and 82.5%) and the German Society for Hygiene and Microbiology (RKI) (between 88.9% and 94.6%). SARS-CoV-2 contact points treated on average more patients with (suspected) COVID-19 (mean 431.59) than primary care practices (mean 83.8) (p<0.001). Leads of SARS-CoV-2 contact point felt more confident to perform anamnestic/diagnostic procedures (p<0.001). The same was found for the confidence level regarding decision-making concerning the further treatment (p<0.001). Several prevention measures to contain the spread of SARS-CoV-2 were adopted.Conclusion Although primary care physicians rose to the challenges of the SARS-CoV-2 pandemic addressing their fears is essential. Next to adequate remuneration for COVID-19 care, support in the clinical and administrative management as well as a robust organisation of care are key issues to prevent exhaustion in the challenge of a prolonged response to the SARS-CoV-2 pandemic.Trial registration The study has been prospectively registered at the German Clinical Trial Register (DRKS00022224).

Mit märkischen Innovationen die ambulante Versorgung gestalten

It is a big challenge to ensure the ambulatory care in economically underdeveloped, rural areas. Some regions of Brandenburg face a shortage of medical care which is primarily caused by the change of generations, the lack of young people and the little existing infrastructure. In these parts of Brandenburg one also sees the consequences of the demographic change: the population is older, less mobile, and the proportion of multi-morbid patients comparatively increased. In addition, the practicing physicians tend to be older and young doctors are becoming less willing to settle in their own surgery. To cope with these challenges the Regional Associations of Statutory Health Insurance Physicians in Brandenburg (Kassenärztliche Vereinigung Brandenburg) invented the KV RegioMed Program. KV RegioMed is a modular concept with regionally tailored solutions which can be combined as needed. The concept meshes medical and non-medical capacities. Competencies and resources can be bundled by outpatient and inpatient areas and intertwined across different sectors.