Persistent symptoms after COVID-19: the post-COVID-19 syndrome?
Dr. Anouk W. Vaes
Abstract: Recovery from COVID-19 can take weeks up to months in previously hospitalized and non-hospitalized patients. Although a large proportion recover fully, part of the patients experience persistent symptoms, such as fatigue, dyspnoea, chest tightness, headache and muscle pain. These persistent symptoms are associated with an impaired quality of life and seriously limit patients’ daily life, as patients experience functional limitations and impaired work productivity, or are even unable to return to work. Many of these so-called `long haulers´ or `long COVID patients´ feel unheard, perceive insufficient support from clinicians, and lack clearly defined healthcare pathways. Therefore, action is needed to improve the management and healthcare of these patients.
Using neuroscience to enhance personnel wellbeing and productivity
Professor Minna Huotilainen
Abstract: This talk discusses neuroscientific findings relevant to worklife. Research related to sleep, nutrition, or physical activity helps employers support the wellbeing of their personnel in long term. In contrast, even during one working day, research shows the benefits of short physical activity to cognitive functions. In addition, research on multitasking and task switching gives important understanding for the development of work strategies. Brain research on cognitive ergonomy covers areas of tools, programs, work arrangements as well as work spaces. Finally, the talk also discusses recent research on empathy skills, highly relevant for workplace wellbeing and leadership.
COVID-19 and rehabilitation: current evidence, and impact on services form a European and Italian perspective
Professor Stefano Negrini
Abstract: The presentation will be two-fold: current rehabilitation evidence and impact on services of COVID-19. Cochrane Rehabilitation has launched the REH-COVER (REHabilitation COVID-19 Evidence-based Response) Action (https://rehabilitation.cochrane.org/resources/cochrane-rehabilitation-versus-covid-19) since March 2020 to systematically collect and make available to all the stakeholders the current evidence on the topic. Research questions have been developed with the World Health Organization Rehabilitation Programme and are at the base of the literature mapping updated monthly (https://rehabilitation.cochrane.org/covid-19/reh-cover-interactive-living-evidence). These services are available for free to the whole community. Since the start of the pandemic, the impact on rehabilitation services has been huge. We calculated (an published) that in the first lockdown up to 2.2 million people did not recive the rehabilitation services they needed. Now the situation has partly revocered, but the impact is still huge.
Socioeconomic outcomes in multiple sclerosis – consequence or tell-tale?
Abstract: Multiple Sclerosis (MS) is chronic disease of the brain and spinal cord that, if untreated, often leads to devastating consequences for the individual, physically, psychologically and socially. 25 years after the introduction of costly disease modifying MS therapies we are starting to see a positive change at the population level with less disability and decreasing costs of illness. To optimize interventions, such as treatments, outcomes are needed that are patient centered, objective and data dense. Here, socioeconomic outcomes, as high level proxies for a biological event, a progressing brain disease, may help not only to direct resources but also to optimize their use.
Panel Covid : Insurance medicine: sharing int. Experience
Pannel Covid : Insurance medicine: sharing int. Experience
Professor Stefano Negrini
SIM Annual Meeting - German Session 3
Selbstbeurteilung versus Fremdbeurteilung der funktionellen Leistungsfähigkeit
Dr. phil. Peter Oesch
Abstract: Patient Reporte Outcome Masure (PROMs) ermöglichen die systematische Erfassung der Patientenperspektiven. Häufig werden dazu Fragebögen verwendet. Verschiedene PROMs erfassen spezifisch die Selbsteinschätzung der arbeitsbezogenen körperlichen Leistungsfähigkeit von Patienten. Dem gegenüber steht die Fremdbeurteilung der der arbeitsbezogenen körperlichen Leistungsfähigkeit mittels standardisierten Testverfahren. Beide Verfahren haben Vor- und Nachteile. Zudem stellt sich die Frage nach deren Aussagekraft im Bezug zur Rückkehr zur Arbeit. Diese Präsentation gibt einen Überblick zu den verschiedenen Testverfahren und macht Empfehlungen zur Anwendung im klinischen Alltag.
Effekt der arbeitsbezogenen Rehabilitation auf die Selbsteinschätzung der eigenen Leistungsfähigkeit
Dr. Martin Schindl
Abstract: Die selbsteingeschätzte körperliche Leistungsfähigkeit stellt einen wichtigen personenbezogenen Prädiktor für die berufliche Wiedereingliederung dar. Die Effekte auf die selbsteingeschätzte Leistungsfähigkeit während und nach stationärer medizinischer und arbeitsbezogener Rehabilitation werden dargestellt.
Funktionsfähigkeit aus somatischer Sicht: outcome in der beruflichen Rehabilitation
SIM Annual Meeting - French Session 1
Comparaison franco-suisse des expertises multidisciplinaires
Dr. Isabelle Gabellon
Marc Emmanuel Fleury
Workshop: implementation of the training programme “acquired brain injury and return to work”
B. Donker1, B. Donker-Cools1, J. van Rijssen1, F. Schaafsma1, J. Hoving1, R. Kunz2 (1Amsterdam NL; 2Basel CH)
As part of a recently finished PhD project scientific knowledge concerning acquired brain injury (ABI) and return to work (RTW) was obtained to support insurance physicians’ (IP)s’ assessments. In addition, to help Dutch IPs to acquire this knowledge, the “ABI and RTW” training programme was developed and evaluated. The results of this project demonstrated that participating IPs’ knowledge increased significantly over time and IPs perceived the training programme to be relevant, useful and appropriate for daily practice. However, the challenge remains to implement this training programme broadly.
We aim, first, to present a short version of the “ABI and RTW” training programme. Second, we intend to deliver an outline of determinants that are relevant for implementation of innovations. Third, we purpose to apply the measurement instrument for determinants of innovations (MIDI) to the “ABI and RTW” training programme in an international context. We specifically aim to focus on facilitators of and barriers impacting on broad implementation. Finally, fourth, we aim to identify a spectrum of possible solutions for perceived implementation challenges with an international audience comprising IPs, scientists and educational experts.
Description of the outline
To achieve the four objectives, we will organize an interactive workshop at the EUMASS congress. This workshop contains four parts: first, participants are briefly informed about the content of the “ABI and RTW” training programme, specifically about relevant factors for RTW after ABI, effective RTW-interventions and patients’ and employers’ personal experiences regarding the RTW-process. Second, participants receive information about determinants that are relevant for implementation of innovations: 1) the characteristics of the innovation, 2) the intended users, 3) the organisation, and 4) the social and political context, according to the MIDI. Third, participants are, if they agree to take part, divided into four subgroups. Each subgroup is asked to indicate facilitators of and barriers to implementation of the training programme according to the four main determinants of the MIDI: 1) innovation, 2) users, 3) organisation, and 4) social and political context. The subgroups rotate along these four determinants, and each subgroup elaborates further on the reported barriers and facilitators of the previous subgroup. Fourth, in a final plenary session overall conclusions regarding the reported facilitators and barriers are drawn. Based on these conclusions we intend to identify solutions to address implementation challenges.
The workshop comprises interactive lectures, quizzes, exercises, case scenarios, small group- and plenary discussions, facilitated by the moderators.
Welcome to the Future: the practical applications of new technologies in social insurance medicine
E. Muller1, J. van Rijssen1, M. Huysmans1, J. Anema1 (1Amsterdam NL)
New technologies, such as e-health applications, tele-medicine, social media, and artificial intelligence, are all around. These technologies are fastly developing, and increasingly applied in the medical field, yet are scarce in the field of social insurance medicine. This offers the interesting opportunity to integrate promising new technological in daily practice of insurance physicians, to improve their work disability assessments, the guidance of people with work disabilities, and to facilitate clients’ return to work.
We aim to create insight into the opportunities and pitfalls of applying new technologies in insurance medicine, and into the broad range of technologies that are potentially applicable. By connecting researchers with interest in this field, we aim to create a sustainable international network that continues sharing experiences on studying and applying new technologies in social insurance medicine.
Description of the outline
After a short introduction, a small quiz will be conducted. This promotes interaction and we will get insight in the knowledge, expertise, and background of the participants attending the workshop.
Next, we will present the intermediate results of a PhD study that we are performing; an overview of applications and tools that seem promising to be used in Dutch insurance medicine setting. Several applications and tools will be presented by short pitches, and will be illustrated with a short video or real life demonstration if possible. Participants are asked to grade the usability (using a digital rating system or post-its, depending on the number of participants) of the presented technologies for use in the insurance medicine field. Furthermore, participant are challenged to name one benefit and one disadvantage of the presented technologies.
Finally, we will explore which new technologies are missing and what other possibilities the participants see for using technologies in the work of the insurance physician, from their own perspectives. We will combine the ideas in clusters of technological approaches. For this, we will use a qualitative research technique for brainstorming, such as the nominal group technique (NGT). NTG is a structured method for group brainstorming that facilitates quick agreement. It involves identifying the problems, generating solutions, and making decisions (by ranking or by a more ‘subjective’ form of evaluation). We will facilitate sharing and discussing the reasons for the choices made by each participant, thereby identifying common ground, and a variety of (combined) ideas.
Short interactive lecture/pitches, plenary discussion/brainstorm (e.g. using nominal group technique), small group discussions, quiz, networking.
Return to work with and after Cancer – a multi perspective point of view
C. Witgeers1, L. Godderis2 (1Antwerpen BE; 2Leuven BE)
Return-to-work (RTW) is an important step in the healing process of cancer patients. There are a lot of benefits associated with return-to-work such as financial, purpose, structure, social interactions, etc. However, a lot of (ex-)patients experience physical, cognitive and psychological side-effects that negatively influence their return-to-work.
In the process of RTW there are a lot of actors involved that contribute to the process and that all have a specific point of view.
It is important that all actors and points of view work together to realize a successful RTW.
* Clarify the role and perspective off the different actors involved in the process of the RTW. (employer, employee, advisory physician from the health insurance, occupational physician; jobcoach, consultant)
* Empathize into different point of view
* Exchange experiences
* Guidance through each step of the RTW process with or after Cancer
* Share good practices (e.g. Rentree, Entree, www.kankerenwerk.be ) and the critical success factors
Description of the outline
By playing an interactive game we guide the participants through some aspects of the RTW process with or after cancer. The game brings in the perspective off the multipotential team around the patient involved in the RTW.
By questions, quotes, propositions,… participants are invited to share their opinions and experiences.
It’s a life boardgame where each participant is necessary to reach the finish, i.e; getting back to work RTW)
Measurement of (Work) Capacities with the Mini-ICF-APP Social Functioning Scale
B. Muschalla1, M. Linden2, S. Christensen3, B. Martin3, B. Martin3, B. Martin3 (1Braunschweig DE; 2Berlin DE; 3Basel CH)
Chronic illness must not only be described on the level of symptoms, but in respect to capacity restrictions and disability. This reflects a bio-psycho-social understanding of illness as outlined also in the ICF (WHO, 2001). For the measurement of capacities special instruments are needed. In the context of mental disorders the Mini-ICF-APP was developed (Linden et al., 2009). It is an internationally validated and used observer rating instrument, which is also suggested in social-medicine guidelines (DRV, 2012; SGPP, 2016).
The Mini-ICF-APP allows to describe the capacity status of a mentally ill person differentiated on 13 (skill) dimensions, with respect to the specific contextf the respective case (e.g. cook, manager, teacher, nurse, IT specialist or any other).
The Mini-ICF-APP capacity rating has been validated until now in several languages. Trainings for clinicians are done in order to improve inter-rater reliability and enable conclusions about social-medicine decisions, such as work ability of mentally ill persons.
The symposium reports new developments and empirical data from studies with the Mini-ICF-APP in different context: type and degree of capacity disorders according to Mini-ICF-APP in the German outpatient context, in Swiss social insurance context, and rater training outcomes.
Short Orals Session 11
Regulation and quality assurance in medical assessment: insights from Australia
G. Grant1, B. Kilgour1 (1Melbourne AU)
Medical assessments are widely used by government and private insurance organisations to generate evidence for decision-making about claimants’ injuries, work capacity and eligibility for entitlements. They operate in a broader context of policies, laws and practices that shape the conduct and duties of stakeholders (including claimants, doctors, lawyers and claims decision-makers). In Australia, as in many other settings, there has been a lack of attention to the diverse regulatory influences on insurance physicians’ work. Better understanding of the legal and policy frameworks will inform improved practice by and support for insurance physicians, quality in their work and use of evidence by decision-makers.
This research maps the various sources of regulation on insurance physicians operating in Australian social insurance and compensation schemes. It also interviews both insurance physicians and the lawyers who engage them in order to shed light on this underexplored area of practice.
This presentation combines (1) findings from interviews with medical assessors and lawyers and (2) legal analysis of policies, legislation and case law relevant to the regulation of insurance physicians’ work. It identifies a range of formal and informal factors shaping the work of insurance physicians undertaking medical and work capacity assessments, including legislation and case law; health practitioner regulation and codes of ethics; contractual agreements; training and accreditation requirements; quality assurance frameworks; court rules and codes of conduct for expert witnesses; and the operation of the market for the selection of insurance physicians as experts for hire.
A diverse range of sources of regulation establish the processes and standards relevant to medical assessments in social insurance and compensation schemes and the obligations of stakeholders. The range and complexity of these influences creates confusion about who is responsible for facilitating quality assurance and improved practice in Australian insurance medicine.
Relevance for an international audience:
Our research offers useful insight about how to identify and reconcile the wide range of sources of regulatory influence on the work of insurance physicians and how these influences may contribute to (or even detract from) the quality of assessments in a range of settings.
Shaping a successful format for international reintegration of foreign clients through a Dutch pilot at the embassy in Poland.
J. Coffeng1, K. Bonefaas2, W. Keizer2, D. Holtkamp2, H. Kroneman2, R. van der Mijn2, H. Romeijnders1 (1amsterdam NL; 2Amsterdam NL)
With the increasing number of foreign employees in the Netherlands, the question steadily arises whether a sick client from UWV (Employee Insurance Agency) can do the assessment and reintegration in "their own" country. Until the end of 2017, there was limited attention for international reintegration. Special Affairs (from the UWV) has since then successfully shaped international reintegration through a pilot at the embassy in Poland. The choice of Poland is a very practical one, namely, the vast majority of our internationally insured clients concerns Polish clients.
Primary question was to evaluate whether the pilot was successful in improving reintegration outcomes. This evaluation was done by means of group interviews with all relevant stakeholders and doing quantitative analyses. Primary analyses that were done concerned reintegration (e.g. the costs for reintegration and number of people that are fit for work). Secondary analyses were done on costs for getting clients to the Netherlands versus having a delegation at the embassy, and possible reduction in sickness benefit costs.
The pilot involved that a delegation from Special Affairs was traveling to the Dutch Embassy in Warsaw to organize reintegration consultation hours and to do assessments of clients. There, clients are seen by an insurance doctor (to indicate the capacity for reintegration) and a labor expert, to be subsequently picked up by the Polish reintegration agency. Our population involved insured persons who were last insured in the Netherlands, and receiving benefits from the UWV (benefits under the Sickness Benefits Act or benefits under the Work and Income (according to Labour Capacity Act (WIA)), currently residing in Poland.
At the time of writing this abstract, results are not to be shared due to the fact that UWV did not approve external communication yet, but at the time of the conference it is very likely that it can be shared widely.
Relevance for an international audience
The free movement of persons (Article 45) gives EU employees the opportunity to work in another EU Member State. This implies that employees who are entitled to a sickness or disability benefit can also rely on this if they live abroad. The costs for these benefits can be high and it might be difficult to do an assessment or to stimulate reintegration of these clients. This pilot can serve as a format that is well-suited for other European countries dealing with similar difficulties for assessing and reintegrating clients abroad.
Social inequalities in health
V. Fabri1 (1BRUXELLES BE)
The Intermutualist Agency (IMA) describes the health inequalities within the Belgian population using data from the 7 Belgian health insurance funds
To study social inequalities in health, the AIM is linking
(1) a social stratification scale: via the tax statistics relating to the statistical sectors in which members reside, it constitutes a social scale composed of five classes of statistical sectors, ranging from the lowest to the highest tax revenues ;
(2) health indicators constructed with administrative data of members and individual data on care reimbursed and medication consumption
The study considers various indicators of health care utilization, health status, mortality and work disability.
Prevention is less achieved when one goes down the social ladder, despite the fact that preventive care (dental care, screening, contraception) is free of charge. Recourse to general practitioners at home and at the hospital emergencies is higher among the most disadvantaged members. The percentage of members treated for chronic bronchopneumopathy and diabetes is higher in the lower social strata. This applies to treatment of mental illnesses such as depression, psychosis or admission to a psychiatric hospital (factor 2.5). The Standardized Mortality Ratio (SMR) shows a particularly strong gradient: individuals belonging to the lowest class have a 56% higher risk of excess mortality in 2016 compared to the highest class. Finally, the number of members with primary work disability (less than one year) is multiplied by 1.5 and those with xork disability (more than one year) by 2.2 in the lowest classes.
Financial accessibility to care should be improved, but the health system is not the only one to blame. Inequalities in health are the result of all the social inequalities present in our society
Social insurance physician burnout in Romania - stress factors and coping strategies
C. Oancea1, A. Cernamoriti1, D. Gherman1 (1Bucharest RO)
Burnout syndrome is well documented and highly prevalent among healthcare professionals. Literature search found studies mainly aimed at front line medical specialties, cardiologists or physicians working in intensive care units. Work load and work conditions favor the occurrence of burnout syndrome among social insurance physicians, with many consequences on health status and decrease of the quality of their work.
We aimed to assess the degree of vulnerability to develop burnout syndrome, factors associated with stress and coping strategies at social insurance physicians.
Social insurance physicians working in territorial services for medical assessment of work capacity from all over the country participated at the study. An observational study was performed to describe the magnitude of the exhaustion syndrome among social insurance doctors. Three questionnaires were filled out by the participants, regarding the degree of burnout, source of stress, stress resistance and stress control. Brief demographic data were also collected. Data were statistically analyzed with appropriate tests using PSPP software. A pilot study on 26 participants was performed in order to analyze the questionnaires and methods to be used and to examine the feasibility of our approach. Of the 26 respondents, 16 were females (61.54%). 38.46% had moderate burnout and irritability resulted as side-effect (p<0 p=0.041) p=0.003), p=0.005)>
More than one-third of social insurance physicians had moderate burnout syndrome. Development of strategies to standardize workload was identified as an important action area, along with long-term preservation of health status and professional performance.
Work Home Interaction and self-perceived health. A cross-sectional study in self-employed health care professionals.
L. Wijnvoord1, S. Brouwer2, M. de Boer3 (1Leiden NL; 2Groningen NL; 3Amsterdam NL)
Balancing work and home responsibilities is a challenge for many. Self-employment is often seen as a way of reducing the conflict between home and work as it is thought to allow more flexible work-schedules. However, not all self-employed dictate their own work hours. Especially self-employed health care professionals generally experience long working hours and limited flexibility, which may negatively affect the balance between home and work.
To examine the levels of work home interaction (WHI) and home work interaction (HWI) among self-employed health professionals and the relation of WHI/HWI with self-perceived mental and physical health. Furthermore the impact of demographic and family variables and work characteristics on this relationship was investigated.
A cross-sectional survey among 1406 self-employed health care professionals was performed. Levels of WHI/HWI were measured by the Survey Work-home Interaction—NijmeGen (SWING). Self-perceived mental and physical health was measured by the SF12. Linear regression analysis was used to evaluate the association between work home interaction (WHI) and home work interaction (HWI) and perceived mental and physical health was evaluated using linear regression analysis. Age, gender, family characteristics and work characteristic variables were included in the models to assess whether they could (partly) modify and/or explain the relationships.
Levels of WHI and HWI were moderate for both male and female respondents. Both genders experienced negative influence from negative HWI and negative WHI on their self-perceived mental health. Neither age, family characteristics nor work characteristics could partly explain of the relation between WHI/HWI and self-perceived mental health.
Work home interaction and home work interaction occur in all age groups and in both male and female self-employed health care workers. Levels of WHI and HWI were moderate. In both genders the imbalance between work and home was associated with their self-perceived mental health, but not with their self-perceived physical health. These associations could not be explained by any of the demographic, family or work characteristics in our study.
Impact on insurance medicine practice:
Our findings indicate that attention should be given to the balance between home and work in both men and women during the entire working life course.
Short Orals Session 12
Perspectives of mental health professionals on labor participation for their clients: a qualitative study
A. de Rijk1, M. Moritz1, F. Feron1 (1Maastricht NL)
The participation in paid work of persons with mental health disorders is significantly lower than for persons without mental health disorders. The setting of mental health care offers opportunities to support labor participation though. The aim of the current study was to explore the perspectives of mental health professionals regarding whether they incorporated aspects of paid work in their treatment and if so, why and how they realized this.
Qualitative thematic analysis was performed after obtaining data from semi-structured interviews with a purposive sample of diverse mental health professionals (n=11) of a middle-sized mental health institute in the Netherlands. The topic list included: the intake process, importance of paid work and involvement of paid work in the treatment, aligning the treatment with other professionals, awareness of the option to refer to the Individual Placement and Support (IPS-) trajectory and use of this option. Data was transcribed verbatim, coded and themes were distinguished.
Whether keeping paid work or finding paid work were addressed during treatment depended on: type of treatment; professional-related and client-related factors. The professionals emphasized that treatment of the diagnosis was their first goal, not keeping or finding work. Professionals felt further hampered by lack of knowledge on labor participation. To clients who had employment, some recommended work adaptions or encouraged them to use the workplace as a setting to practice new behaviors. How mental health care professionals addressed the issue of paid work depended on how they aligned the treatment with other professionals, whether they were aware of the availability of IPS, whether they referred to other types of health care and depended on their contact with the client’s social insurance and occupational health physician.
Treating the diagnosis of the client seems the primary goal, and as long as it does not interfere with the treatment, the issue of paid work is ignored. The support by mental health professionals of participation in paid work might be improved by: increased attention to paid work by mental health professionals, improved collaboration with other professionals (among which social insurance physicians), and financial investment in the availability of IPS might improve.
Impact on social insurance practice
Mental health care professionals shape their treatments differently when they contact the client’s social insurance physician, but scarcely do so. More intense collaboration is expected to increase opportunities to participate in (part-time) paid work for persons with mental health disorders.
Psychosocial work environmental factors and workplace health, a systematic literature review
P. Lytsy1, E. Friberg1 (1Stockholm SE)
The psychosocial work environment is of importance for the health of individuals and organizations.
To map the existing knowledge, as presented in relevant and well performed systematic reviews, that have investigated associations between psychosocial work environment factors and relevant health related outcomes for the individual as well as for the organization.
Systematic reviews of existing knowledge in relevant and well performed systematic reviews were sought without time restriction in three electronic databases: PubMed, PsycINFO, and Cinahl. Two authors independently screened all references and abstracts. Potentially interesting articles were read in full text and their relevance for the objectives were assessed independently by two authors. The quality of the relevant systematic reviews was then independently assessed using a validated instrument. Systematic reviews of moderate or good quality were included in the systematic review.
A total of 42 systematic reviews studying psychosocial work factors’ associations to individuals’ health or the wellbeing of the organization were included. The main psychosocial work environment factors which were investigated were different models of strain due to stress, conflict and mobbing. About half of the included systematic reviews investigated associations between psychosocial work environment factors and mental health and about half of the systematic reviews investigated associations to somatic disorders, mainly cardiovascular disease, musculoskeletal disorders and pain. Most of the included systematic reviews based their results on workers/employees in general, whereas five systematic reviews focused on workers within health care and veterinary organizations, and a few focuses on other work areas such as industrial workers, police and correctional workers, and people working with occupational groups affected by disasters. Only a few of the included systematic reviews investigated or presented the results as psychosocial factors being protective or salutogenic. The vast majority of the included systematic reviews investigated psychosocial work environment factors as being risk factors for the development of illness, disease or consequences of disease, such as sick leave.
A substantial amount of well performed systematic reviews add to the evidence that psychosocial work environmental factors can both be viewed as risk factors for the development of illness, disease and consequences of diseases such as sick leave, whereas sometimes also described as being protective and balancing factors in such regard.
Impact on insurance medicine practice
The psychosocial work environment is of importance for the health of individuals as well as for the levels of sickness absence in organizations.
The need of and access to medical rehabilitation. A retrospective secondary data analysis.
T. Petzold1, J. Hiebsch1, W. Klene1 (1Dresden DE)
The access and demands of rehabilitation services serve to prevent disability, to improve chronic illnesses and disabilities, and to promote vocational reintegration. In order to determine the need and access for rehabilitation in Germany, the medical service of the health insurance (MDK) must examine applications of the insured. The statutory health insurance funds are obliged to have at least every fourth application for rehabilitation services assessed by MDK-physicians. The aim of the assessment is to evaluate the need for and access to rehabilitation.
The aim of the study is to analyse the prevalence in the application behaviour of rehabilitation service as well as its regional variance in Saxony.
A retrospective secondary data analysis of Saxon insured persons for the years 2017 and 2018 was carried out. All application for rehabilitation services awarded by the MDK Saxony was included in the study. The descriptive analysis of the data included the concrete reason of the assessment, the result of the MDK-assessment, and the regional variation of the application behaviour. For regional representation and comparability, age and gender adjustments were made so as raw values were reported. The district data of the population of the Federal Statistical Office from the GENESIS database were used for standardisation.
There were 35,282 applications for rehabilitation services. The most frequent assessment reasons included the initial application of inpatient rehabilitation (50%; n=17,818) and the extension of inpatient rehabilitation (17%; n=6,114). In 57% (n=20,024) of the applications, the MDK-physician considered the medical prerequisites for granting to be fulfilled. In 27% (n=9,570) the medical requirements were assessed as not fulfilled and in 16% (n=5,688) the available information was incomplete and a new assessment recommended. The regional analysis revealed differences between the Leipzig with 53.1 applications per 100,000 inhabitants and the district of Saxon Switzerland with 137.4 applications per 100,000 inhabitants. With increasing age the application behaviour raises up to 295.3 applications per 100,000 inhabitants.
The results show significant regional as well as age-specific variations in the application behaviour of rehabilitation services of insured inhabitants in Saxony. Even as this is a selective, non-quantifiable sample, determinants influencing the application behaviour are distinct. Further research is necessary to clearly identify the determinants.
The linkage of the available data with further data can make an important contribution to the evaluation of rehabilitation services, the socio-medical status of insured and for the further development of health care.
Variation of work participation outcomes and measurement methods in trials: a systematic review.
M. Ravinskaya1, M. Langendam1, R. Kunz2, J. Verbeek3, S. Verstappen4, I. Madan5, J. Daams1, C. Hulshof1, J. Hoving1 (1Amsterdam NL; 2Basel CH; 3Kuopio FI; 4Manchester GB; 5London GB)
We performed a systematic review to explore the extent of outcomes and measurement methods heterogeneity in trials that directly and indirectly impact work participation. We searched Medline, Embase, PsycINFO and Cochrane Library for RCT’s published between 01/01/2014 and 21/05/2019. Trials were included on any type of intervention which measured work participation outcomes, with participants of the working age, who were either currently employed or seeking competitive employment. A total of 10,222 abstracts and 819 full text articles were screened, and 500 articles were eligible for inclusion. We looked for patterns in work participation outcome reporting in relation to disease type, intervention type and geographic location.
A large amount of heterogeneity in outcome reporting was established. Authors rarely report on why certain outcome measurement methods are chosen. Results show that outcomes can be distributed around four pre-defined main outcome categories: employment status; employability; absence from paid work and at-work productivity loss. The results of our study will be used as input for developing a Core Outcome Set for Work Participation.
The results of this systematic review will be presented during EUMASS 2020. Interim analyses show a great need for a set of consistent definitions on key constructs and outcomes on the outcome concept work participation.
Short Orals Session 13
Barriers and facilitators to sustainable employment: the case of spinal cord injury and acquired brain injury
K. Karcz1, B. Trezzini1, B. Schiffman2, M. Finger1 (1Nottwil, Lucerne CH; 2Nottwil CH)
Sustainable employment refers to a match between a person – job – workplace that enables a person to stay healthy and satisfied at work over time, with a work performance that meets the expectations of the person and the employer. Achieving sustainable employment for people with a spinal cord injury (SCI) or an acquired brain injury (ABI) remains to be a challenge as shown by their lower work participation in comparison to the general population. The aim of this study was to identify barriers and facilitators to sustainable employment as reported by people with SCI or ABI.
To explore barriers and facilitators to sustainable employment of people with SCI or ABI 14 focus groups were conducted (7 SCI, 7 ABI). All participants (n = 46) had been employed at some point after injury. A maximum variation sampling strategy was applied in order to select participants who represent a wide range of demographic attributes, injury characteristics, work features and labor market participation. Data were synthesized using a thematic analysis.
The gathered data reveals the importance of person characteristics and environmental factors. The participants of all groups highlighted that besides personal motivation, learning to be a strong self-advocate plays a crucial role in staying employed. Environmental factors such as flexible work schedules, adapted task profiles, committed employers and understanding colleagues seem to be the main facilitators of long-term employment. As a consequence of their higher mobility limitations, individuals with SCI encounter more difficulties in accessing the workplace and time organization. Furthermore, secondary health conditions, such as chronic pain, urinary tract infections, or pressure sores are prevalent problems and barriers to work sustainability. In contrast, individuals with ABI emphasized experiencing difficulties in particular because of invisible impairments such as fatigue, problems with concentration, memory and personality changes. In addition, individuals with ABI tend to struggle with performance limitations due to cognitive, emotional, and behavioural problems.
Findings from this study inform about the main barriers and facilitators encountered by people with SCI or ABI on the labour market. Both personal and environmental factors, directly and indirectly related to work, emerged as crucial for sustained employment. Identifying barriers and facilitators to sustainable employment of people with SCI or ABI provides practitioners with the knowledge essential to design effective interventions, which are fundamental to support not only vocational reintegration but also to promote sustainable employment.
Developing an occupation-specific job matching tool for reintegrating persons with spinal cord injury into the labor market.
M. Nützi1, B. Trezzini1, S. Staubli1, E. Ronca1, U. Schwegler1 (1Nottwil CH)
Sustainable return to work of persons with disabilities requires a good match of a person’s capabilities, characteristics and health condition-specific needs with the demands and characteristics of their job. Therefore, job matching represents a key procedure in vocational rehabilitation of persons with disabilities. However, currently available job matching tools do neither allow for a comprehensive documentation of the key aspects of job matching, nor do they lend themselves to describe the demands and characteristics of particular occupations.
The present study thus aimed at developing and pretesting a comprehensive occupation- and health condition-specific job matching tool for vocational rehabilitation by using persons with spinal cord injury as a case in point.
The study design involved qualitative and quantitative steps. First, an interdisciplinary scoping review covering return-to-work, organizational and vocational psychology research was conducted to devise a conceptual job matching framework for vocational rehabilitation. Then, the occupation- and health condition-specific tool content was determined based on a database analysis of jobs performed by persons with spinal cord injury and focus groups with affected persons. Finally, a tool prototype was developed and pretested in a simulation exercise with vocational rehabilitation professionals.
The study yielded a tool prototype with matching profiles that structure the demands and characteristics of 415 occupations as well as spinal cord injury-related needs and limitations into a stable, a modifiable, and a needs-supplies dimension of person-job match. Vocational rehabilitation professionals perceived the tool as helpful for determining customized target jobs for vocational retraining and for deriving goal-oriented interventions in the interdisciplinary setting of vocational rehabilitation.
By comprehensively assessing the person-job match of individuals with spinal cord injury, the tool facilitates a customized determination of target jobs and a goal-oriented intervention planning in vocational rehabilitation and is thus likely to promote sustainable return to work of the affected persons.
Reference: Nützi, M., Trezzini, B., Staubli, S., Ronca, E. & Schwegler, U. (2019): An interdisciplinary approach to job matching: developing an occupation-specific job matching tool for reintegrating persons with spinal cord injury into the labor market. Disability and Rehabilitation, DOI: 10.1080/09638288.2018.1561958
Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis with a matched reference group: a Swedish study
C. Murley1, K. Karampampa1, K. Alexanderson1, J. Hillert1, E. Friberg1 (1Stockholm SE)
Multiple sclerosis (MS) typically onsets in the years one is active on the labour market and may lead to reduced work capacity. Knowledge about the diagnoses for sickness absence (SA) and disability pension (DP) among people with MS (PwMS) is lacking.
Explore diagnosis-specific SA and DP among PwMS and matched references in the years before and after MS diagnosis and analyse the risk of being granted DP after MS diagnosis.
Longitudinal nationwide Swedish register data on 2567 people who in 2009-2012 were diagnosed with MS when aged 25-59, and 10,268 population-based references (matched on sex, age, educational level, type of living area, and country of birth) were analysed regarding annual diagnosis-specific SA and DP in the 4 years before and 4 years after the MS diagnosis date. Annual differences in mean numbers of SA and/or DP net days were calculated with 95% confidence intervals (CI). Hazard ratios (HR) with 95% CI were estimated with Cox proportional hazard models for being granted DP (all-diagnoses and diagnosis-specific) after MS diagnosis, comparing the PwMS and references.
The mean SA/DP days/year increased among PwMS over follow-up, due to both MS and other diagnoses. During follow-up, around 50% of PwMS had some SA/DP compared to 20% of references. The mean days of SA/DP among the PwMS compared to references increased from 10.3 more days (95% CI: 6.6-14.2) 4 years prior to MS diagnosis to 68.9 days (62.8-75.1) 4 years after MS diagnosis. Although most future DP among PwMS were with MS, 15% were not. The adjusted HR for a new DP spell (all-diagnoses) among PwMS during follow-up was 23.1 (18.1-29.5). The risks of being granted DP with musculoskeletal or mental diagnoses were higher among PwMS (HR 2.6 and 2.0, respectively) compared to references.
PwMS had higher levels of SA and DP days/year than the references, already 4 years before the MS diagnosis, and increasingly so thereafter. The excess of SA/DP prior to MS diagnosis could be related to MS onset. However, the excess of SA/DP were not all due to MS diagnoses, even after being diagnosed with MS. PwMS had a higher risk of having a new DP after being diagnosed with MS in total, but also for diagnoses other than MS.
Impact on insurance medicine practice:
PwMS have more SA and DP days than references and higher proportions on SA/DP, not only due to MS but also other diagnoses.
Evaluation of influencing factors for Return To Work (RTW) in patients with chronic pain: the use of a screening tool.
M. Vander Plaetse1, N. Millen1, S. Decuman2, R. Jakers1, A. Verheyen1, K. Goorts3, L. Godderis3, G. Crombez4 (1Hasselt BE; 2Brussels BE; 3Leuven BE; 4Ghent BE)
With about 20%, prevalence of chronic pain is very high in Europe. As we know, the burden of chronic pain is very high, on personal (physical, emotional, social) as well as on societal level, resulting in high (in)direct costs. The latter is caused by among others high rates of work incapacity, with especially an increase in long term incapacity (one year or more). The risk of long term work incapacity rises especially after a sick leave period of 3 months or more.
Furthermore, there is a relation between not working and early death, higher incidence of suicide and higher risk on psychological problems and general health issues.
Therefore, supporting the chronic pain patient towards a feasible return to work (RTW) is essential and therefore early identification of influencing factors for RTW is needed.
The objective of this study is to develop a screening tool in order to detect as soon as feasible the focus of follow-up towards RTW and to facilitate communication between all parties.
After performing a literature study, three expert groups were organized. By means of a nominal group technique work and pain related indicators who should be assessed were selected. Moreover, short clinical tests evaluating functional capacity which should be used were listed, based on literature and expert opinion.
The tool consists of a brief questionnaire and a short clinical test. Results are shown in two parts: part one summarizes the motivational aspects and clinical test. The results of part two (influencing factors) are shown in a visual (Figure 1).
A screening tool has been developed, of which the rough version is finalized; it was successfully evaluated on user friendliness (medical doctor and patient). Further validation studies will be done before broad implementation.
Impact on insurance medicine practice
The broad implementation of a screening tool could facilitate the communication and approach needed for supporting chronic pain patients towards a successful RTW.
Predictive validity for a non-return to work of the Modified Spinal Function Sort (M-SFS)
D. Riese1, J. Kool1, M. Trippolini2, B. Jansen3, P. Oesch1, M. Schindl4 (1Valens CH; 2Bern CH; 3Bellikon CH; 4Klosterneuburg AT)
According to the Global Burden of Disease Study, musculoskeletal disorders (MSD) are a major cause of incapacity for work. Long-term disability in patients with MSD is often associated with low perceived self-efficacy (PSE). In addition, lower PSE is associated with poorer health outcomes and return to work (RTW). The Modified Spinal Function Sort (M-SFS) is a patient reported health measure to evaluate work-related PSE. The M-SFS contains 20 drawings of physical activities with simple written descriptions. Each task is rated on a 5-point Likert scale ranging from “able” (4 points), to “restricted” (3, 2 or 1 points) or “unable” (0 points) adding up to a total score from 0 to 80. Previous research supports reliable and validity of the M-SFS. However, the predictive validity of the M-SFS for RTW is unknown and is evaluated in this study.
Multi-centre prospective cohort study in patients with MSD with PSE assessment at baseline and evaluation of work activity at three months follow-up. Inclusion criteria were non-specific MSD > 3 months, no co-morbidity limiting work ability and informed consent. PSE was evaluated with the M-SFS with a total of 0-80 points and higher scores representing higher PSE. RTW was dichotomized depending on the number of work days (0 or 1-90). We investigated the predictive validity of the M-SFS to predict RTW by receiver operating characteristic (ROC) curve analysis. An Area Under the Curve (AUC) was considered acceptable if >0.7 and excellent if >0.8. We determined the cut-off value for the optimal prediction of RTW and non-RTW and determined specificity and sensitivity.
Preliminary results concern 105/164 participants. The mean M-SFS score was 62.7 (SD 13.6). RTW rate was 58%. M-SFS prediction of RTW was excellent, the AUC was 0.828 (95%CI 0.749 – 0.907). M-SFS values <57>
The M-SFS for the evaluation of perceived self-efficacy for work-related tasks has excellent predictive validity for RTW. Scores <57>80% sensitivity and specificity.
SIM Annual Meeting - German Session 4
Aktuelle Befunde zum Nutzen einer psychiatrischen Standarddiagnostik in der Versicherungsmedizin: Die «VSD»-Studie
Erfahrungen aus der Neuropsychologie: wie objektiv ist objektiv?
Erfahrungen aus der Rely-Studie: wie objektiv ist objektiv? Gibt es allgemeingültige learnings?
SIM Annual Meeting - French Session 2
Echange d’informations et secret médical
Dr. Olivier Galland
Docteur David Macheda
Abstract: Les communications entre assurances Suisses et assurés soignés en France, se heurtent à des conceptions différentes du secret médical entre les 2 pays. Secret absolu en France, détenu par le patient, quelques exceptions pour les communications avec le médecin conseil de la sécurité sociale. Cependant qu'en Suisse la communication avec les médecins traitants et l'assurance est possible. Un Travail Franco-Suisse, nous a permis d'établir des modalités de coopération entre médecins.
Dr Galland Olivier
Abstract: Les communications entre assurances Suisses et assurés soignés en France, se heurtent à des conceptions différentes du secret médical entre les 2 pays. Secret absolu en France, détenu par le patient, quelques exceptions pour les communications avec le médecin conseil de la sécurité sociale. Cependant qu'en Suisse la communication avec les médecins traitants et l'assurance est possible. Un Travail Franco-Suisse, nous a permis d'établir des modalités de coopération entre médecins.
Spinal Cord stimulation for chronic pain management: Novel technology or hoax? Insights from a meta-analysis from an insurer’s perspective.
R. A. Kunz1, A. Sarrafzadeh1, H. Schmidt1 (1Lucerne CH)
Following accidents and chronic disease, chronic pain can be a long‐term complication in patients that is difficult to treat and that may result in long-term work disability. In recent years, electric stimulation therapy of the spinal cord (SCS), an invasive and expensive intervention, is increasingly promoted in the management of intractable chronic pain. To better understand the benefits of SCS, we followed Cochrane guidance and conducted two systematic reviews of randomized trials (RCTs) a) comparing medical management versus SCS (3 studies) , and b) comparing novel systems of SCS vs. classic systems (high vs. low frequency; burst wave vs. tonic; dorsal root ganglion vs. dorsal column) on patient reported outcomes (5 studies). Given the heterogeneous findings in the systematic reviews, we will use the technique of evidence-based medicine to critically appraise the evidence and determine our certainty in the observed findings.
We inform participants about the current body of evidence from RCTs about the benefit of spinal cord stimulation versus other treatment options. We guide participants through key issues of randomized studies (small and large group) that determine the certainty in the evidence. We introduce patient important outcomes in pain trials. We determine the certainty that SCS are beneficial interventions
Description of the outline:
Patient scenario; The technology ‘Spinal Cord Stimulation’; The evidence: Summary of RCTs; Critical appraisal of methodological features with strengths and weaknesses (examples); Discussion of selected results; Conclusions by the audience.
Interactive presentations by all three speakers set up as a discourse with the audience with slots of presenting content followed by discussion slots, planned by speakers or initiated by the audience. Engagement with the audience will be stimulated by questions and little exercises that should be discussed with their neighbors and results being shared with the large group.
Insurance medicine professionals with an interest in evidence based medicine applied to the practice of insurance medicine when steering the provision of novel health technologies; Professionals want to learn about current knowledge of spinal cord stimulation in the management of chronic pain; Participants have a understanding of the principles and basic concepts of evidence-based medicine.
Sustainable work for persons with disabilities: Bridging rehabilitation, integration and disability evaluation
U. Schwegler1, M. Finger1, M. Nützi1, K. Karcz1 (1Nottwil CH)
Sustainable work is a core topic in social security schemes because it not only fosters health and quality of life of persons with disabilities but also promises cost savings for social security insurance providers and the entire social security system. The recent years, however, were characterized by an increasing fragmentation in social security systems along with a focus on short-term outcomes such as a fast return to work or isolated questions such as work capacity determination without sufficiently taking into account the long-term perspective of employment retention. Yet taking a life course perspective on affected persons’ vocational integration paths is crucial to overcome interfaces between different settings (i.e. rehabilitation, integration, disability evaluation) and providers in a social security scheme (i.e. health, accident and disability insurers).
By taking Switzerland as a case in point, the symposium aims to
(1) introduce a life-course approach to sustainable work integration of persons with disabilities;
(2) present the development of goal-oriented tools and strategies for a systematic alignment of vocational rehabilitation, integration and employment retention services and disability evaluation procedures towards a sustainable work;
(3) discuss efforts fostering a sustainable work integration and an effective interface management in social security schemes from an international perspective.
Short Orals Session 14
Design of hospital care billing controls in Slovenia
I. Querrioux1, M. Gaber1 (1Ljubljana SI)
Controlling the billing for hospital care is part of the control activity performed by the Health Insurance Institute of Slovenia (HIIS or ZZZS: Zavod za Zdravstveno Zavarovanje Slovenije).
Every year significant miscalculations are discovered while performing controls of the billing for hospital care.
In Slovenia, hospital activity is calculated on the basis of DRG codes (Diagnosis Related Group). The coding applies the Coding Standards - Australian Version 6, Slovenian Supplement.
Appendix C to the Coding Standards, called the Slovenian Supplement, resolves some of the ambiguities encountered while performing our controls and gives instructions for correct coding in typical types of hospital treatments.
The ZZZS regularly monitors the number and the types of DRG codes reported by each contractor. By analyzing the received information, we monitor compliance with coding standards, billing rules applicable in Slovenia and with the instructions given while performing controls.
ZZZS carries out controls every year in all hospitals. The number of controls performed depends on the size of the hospital and on the data obtained.
Part of the controls are specifically planned at contractors who significantly step out in the calculation of different DRG codes, based on the size of the institution and the data they reported. A significant number of controls are planned in a way that we check the same types of DRG at most contractors.
In 2018, ZZZS performed 790 controls in total. 400 were administrative controls and 390 were performed by healthcare professionals directly at the contractors, 66 of which were controls over billing for hospital activity.
In the year 2018, 346 782 cases of acute hospital treatment were counted. Slovenian population that year was just over 2 millions inhabitants, which means that on average every 6th person benefited from hospital care. The services were provided by 29 contractors, including 2 university hospitals, 10 general hospitals, 7 specialized hospitals and 10 private hospitals.
Last year, an average of 19.8% of miscalculations were found. Thus there was a total of 1 221 857,38 EUR of inadequatly charged services, which represents just over 18 500 EUR per individual control.
Designing controls of the billing for hospital care is a challenging task. Their main goal is to ensure fair and unified coding practices over the slovenian territory.
Occupational diseases in self-employed workers in France
F. Latil1, B. Neme2 (193400 SAINT-OUEN FR; 2SAINT-OUEN FR)
Occupational diseases in self-employed workers in France
In France, self- employed workers receive disability benefits, but are outside of the specific legislation protecting employees from occupational accident and diseases. Physicians are generally not aware of this shortcoming and ask for occupational diseases benefits, for their patients as they do for salaried employees. The health fund of independent workers (HFIW ), dismiss the application, which is uphold by law, but can be a threat to the patient, if it shutters hope for other available benefits. Our aim was to see if the request for occupational diseases was related to significant disability in self-employed workers, and if such a disability could be handled by available benefits from HFIW. This survey could be instructive for countries without occupational diseases frame for self-employed workers.
A prospective study was conducted on self-employed claimants applying for occupational disease, from June 2015 to September 2017, with an 18 month period follow-up, in the Ile- de- France region. A questionnaire was sent to the claimant and the data were completed through a phone call or appointment. The main outcome was the number of claimants qualifying for disability benefit available at the HFIW.
148 claimants were identified and 141 (95%) matched with the occupational diseases legal setting. The causative agents were close to those observed in employed workers: musculoskeletal, asbestosis. Disability allowance, complete or partial, could be provided by the HFIW because the medical criteria were met in 38 claimants(27%) ; benefits for asbestosis exposure were possible through a specialized body for 16 claimants (11%).
The occupational disease request from self-employed workers matched with medical conditions granted by the HFIW, or external social bodies. An Immediate apply for disability benefit could be set up for 27% of the claimants.
Impact on insurance medicine practice
A screening of the claim for occupational disease in self-employed patients could be routinely implemented by nurses or any insurance officer.
The effectiveness of living labs for successful implementation of innovation in healthcare: a systematic review
N. Zipfel1, B. Horreh1, C. Hulshof1, A. de Boer1, S. van der Burg-Vermeulen1 (1Amsterdam NL)
The concept of living labs gained increasing attention over the past decade as a research method to enhance participation of end-users in the development and implementation process of an innovation. In healthcare it is unknown if the living lab approach can achieve better practice-wide implementation.
The objective of this systematic literature review is to summarize the literature on the effectiveness of a living lab approach on successful implementation of innovations.
A systematic literature review was conducted searching the Pubmed, Embase, Psycinfo and CINAHL databases to identify papers reporting on livings labs and successful implementation. The search terms for the concept of living labs include : living lab, collaborative innovation, co-creation, co-creation of knowledge, co-design, co-production, collaborative action research and participatory action research. To evaluate the effect of living labs on successful implementation, studies are included that describe successful implementation as innovations that are implemented in standard practice . Data extraction is performed using a pre-defined data extraction form and risk of bias is assessed with the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. No restriction on study type is incurred. For the data synthesis a narrative synthesis is used. We anticipate that there will be limited scope for meta-analysis and pooling of data as the studies are expected to be heterogeneous.
A preliminary search yielded 1095 unique papers that will be screened. The results will be available at the time of the conferences and are currently underway.
It is anticipated that living labs add value to the implementation of innovations due to its interactive and iterative nature with end-users and other important stakeholders. More insight into the added-value of living labs may guide future healthcare innovation projects, including the field of insurance medicine.
Impact on Insurance medicine in practice
The results of this review may help insurance medicine to enhance participation in co-creation of innovations with the goal of improving quality of practice. Furthermore, the results may support introduction of living labs as surplus value to enhance practice-wide update of innovations in insurance medicine.
Turning Swiss health insurance claims data into a data base for decision making
B. Brüngger1, C. Huber1, E. Blozik1 (1Dübendorf CH)
In absence of valid population-based clinical data, claims data from mandatory health insurance provide a valuable data source for health services research in Switzerland. The claims data are routinely collected, available from all parts of the country, across all age groups of the population, and cover detailed information from both the outpatient and the inpatient healthcare setting.
The aim of this presentation is to describe the potential of health insurance claims data by giving insights into one such database, and by providing an overview of health services research studies based on this database.
All presented studies are based on anonymized records from the mandatory health insurance claims database of the Helsana Group. Helsana is one of the largest health insurances in Switzerland, covering about 1.2 million obligatory insured persons across all 26 cantons. Descriptive and multivariable regression analyses were performed to determine the study results.
The presentation shows the strengths and limitations of health insurance claims data as a data source and its potential to draw conclusions about the use of health services. In addition, presented examples demonstrate how illustrative real-life information can be derived from claims data. Particular attention will be paid to analyzing patient and health care provider behavior (such as guideline adherence) and patterns of resource utilization (e.g. medication use).
The presentation illustrates applied examples of health services research based on health insurance claims data. The results help to describe and quantify the burden of potential over-, under- and misuse of health care. Providing these findings is important to implement instruments for improvement of healthcare quality. Moreover, the data are very useful as a basis for decisions making in health care management. The presented methods may also be transferable to other sources of routine data.
The presentation shows how insurance companies can use own resources to monitor the use of the health care system and implement quality measurements.
Short Orals Session 15
Enhancing Return-To-Work Among Partially Work Disabled Persons: Development Of A Triage Instrument And Decision Aid For Vocational Rehabilitation Experts.
C. de Geus1, M. Huysmans1, J. van Rijssen2, J. Anema1 (1Amsterdam NL; 2Amsteradm NL)
The vocational rehabilitation of partially disabled persons who have been partially work disabled for more than 90 days due to longstanding health problems or a disability can be difficult for vocational rehabilitation experts. A triage instrument and decision aid can give vocational rehabilitation experts such as insurance physicians an evidence-based understanding of the most relevant return to work (RTW) factors and effective RTW interventions for this population.
We aim to develop a triage instrument and decision aid to support professionals in delivering evidence-based, individually tailored service to improve RTW of partially work disabled persons receiving a long term disability benefit. The instrument and decision aid will be developed along the lines of the International Classification of Functioning, Disability and Health (ICF model). The decision aid provides the professional with relevant options for effective interventions. These interventions are selected with the goal to reduce the obstructing RTW factors and strengthen supportive factors. The factors that serve as input for the instrument are provided by, amongst others, the insurance physician.
Currently, two literature reviews have been conducted. The first review is a meta-review that focusses on relevant barriers and facilitators for RTW for employees who have been sick-listed for at least 90 days. The second review focusses on effective RTW interventions for employees who have been sick listed for at least 90 days. Based on the results of the systematic reviews, a Delphi study among vocational rehabilitation experts - including insurance physicians - will be held in the beginning of 2020 to reach consensus on the content and design of the final instrument.
The preliminary results of the meta-review of relevant RTW-factors show 101 factors such as: motivation to RTW and self-efficacy. The preliminary results of the review on RTW-interventions show, amongst other things, that Individual Placement and Support is an effective RTW intervention for persons with a mental illness.
The aim of this study is to develop a triage instrument and decision aid for vocational rehabilitation experts to enhance and support evidence-based, individually tailored service to partially disabled persons. The instrument will be developed based on the results of a Delphi study, of which the results will be available in September. In our next study we plan to evaluate the (cost)effectiveness of the instrument in a randomized controlled trial.
Impact on insurance medicine practice.
The instrument and decision aid will help vocational rehabilitation experts in making evidence-based decisions on effective interventions for partially work disabled workers.
Labor market trajectories of young disabled people applying for disability benefits
F. Abma1, T. Hoekstra1, S. Brouwer1 (1Groningen NL)
For young disabled persons the transition into entering and staying in the labor market is not without difficulties. Their labor market entry often shows an insecure and volatile nature. However, existing studies often have short follow-up periods and look at single periods instead of transitions as sequences.
The main aim of this study is to gain insight in the various long-term labor market trajectories of young disabled workers.
Data from the ‘Young Disabled at Work’ prospective cohort study was used, following N=3455 young adults with disabilities, aged between 15-27, applying for disability benefits. Seven year follow-up data regarding labor market status were obtained by data-linkage with Statistics Netherlands (CBS). Labor market outcomes were divided into 3 mutually exclusive categories: 1= Working (either with contract or self-employed); 2= Partially active (Recipient of any social security benefits and working; in education; and working member in family business); 3= Inactive (Recipient of social security benefits (including young disability benefits, unemployment, work disability, welfare old age pension; or other without income) for each month.
The mean age of applicants was 23.4 years, and 45.1% was female. Psychiatric and developmental disorders was the most common diagnosis in both granted and rejected applications, respectively 41.2% and 44.3%. When looking at the 20 most common trajectories, the stable Inactive group (N=926, 71,7%) is by far the largest group. N=62 (4,8%) applicants were stable at work in the years after application for benefits. Of the group starting in the Partially active group, the vast majority ends up in the Inactive group in the follow-up period, while a small group ends up in the Working group or remains in the Partially active group.
Conclusion and impact
These findings show a problematic transition into work for many young adults with disabilities. The vast majority ends up inactive on the labor market receiving. Many young adults that enter the labor market at some point are unable to maintain their active role in the labor market. The challenge is to help these adults persevere their labor market participation by providing the activating support and guidance.
Sickness absence among young adults employed in the private sector
J. Narusyte1, P. Svedberg1, A. Ropponen1 (1Stockholm SE)
Mental health problems as well as sickness absence (SA) due to mental diagnoses are public health problems among young adults in Sweden. However, knowledge is lacking on whether experiencing mental health problems at young ages is of importance for future SA.
The aim was to investigate whether occurrence of SA among young adults employed in the private sector differed depending on presence of depression and/or anxiety symptoms in adolescence .
The study included data on 11,441 twins born in Sweden 1959-1986 and employed in private sector. A total of 9698 twins were participants of a web-based survey STAGE conducted in 2005, and 1743 twins were participants of a longitudinal study of development of behaviour problems, TCHAD. Information on depression and anxiety was obtained from the surveys, when participants were 20-44 (STAGE) and 16-17 (TCHAD) years old. Data on employment sector and on occurrence of SA until 2013 were obtained from national registries. Frequencies and length of SA and among those who experienced depression and/or anxiety in adolescence (TCHAD) and young adulthood (STAGE) stratified by sex.
Preliminary results showed that 45% of the women and 28% of the men had at least one SA spell during the follow-up. Among STAGE participants who have experienced depression and/or anxiety in young adulthood, the occurrence of SA was higher (66% and 44% among women and men, respectively) compared to those who did not experience depression or anxiety in young adulthood (45% and 28% among women and men, respectively). Among TCHAD participants who have had depression/anxiety in adolescence, 38% of the women had at least one SA-spell during follow-up, which was only slightly higher than SA-occurrence among women without depression/anxiety in adolescence (35%). The majority of the men with SA during follow-up did not have depression/anxiety in adolescence.
Occurrence of SA among both women and men were more common among those who have experienced depression and/or anxiety in young adulthood.
Impact on insurance medicine practice
Depression and anxiety in young adulthood seem to have a long-term impact on work capacity. The results suggest that aspects related to work capacity may be an important part of treatment of depression and anxiety with a purpose to prevent future sickness absence.
Vocational rehabilitation services for young persons without precondition of illness or impairment - new approaches to assessment for disability prevention
J. Löfstedt1, K. Koskenvuo1, J. Rouvinen2 (1Helsinki FI; 2Kuopio FI)
In Finland, as in the most OECD countries, the number of young adults receiving disability pension has increased. The use of sickness-based benefits, such as the disability pension, has more than doubled among young people during the past twenty years. In addition, the proportion of young people neither in employment nor in education or training (the NEET rate) is high in Finland compared to the other Nordic countries.
Kela, the Social Insurance Institution of Finland, looks after basic security for all persons resident in Finland through the different stages of their lives. The statutory duties of Kela include proposing improvements to the legislation governing social security. In addition, Kela is responsible for carrying out research contributing to the development of social security.
In 2017, Kela was tasked with developing rehabilitation services targeted to young people under the age of 30. The aim was to ease the criteria for the vocational rehabilitation services and make the process of applying for vocational rehabilitation services more flexible. A development project focusing on rehabilitation services for NEETs was established to prepare the amendments (2018-2019).
Based on the experiences of the development project, including the new vocational rehabilitation service titled “NUOTTI-coaching”, the criteria for the vocational rehabilitation of young people were eased by removing the preconditions of illness or impairment. As part of the project a recommendation was made (in collaboration with the National Institute for Health and Welfare), based on the ICF framework, on how to evaluate the functional capacity of young people without having perform a diagnosis. This recommendation is aimed at experts, such as youth workers, who are in direct contact with young people.
Substituting the terms used in the ICF framework for the preconditions of illness or impairment represents a new approach to assessment aiming at disability prevention. The possibility for young persons to have more timely and flexible access to rehabilitation services has been received positively. The number of recipients of vocational rehabilitation services for young persons has increased significantly during 2019. By the end of October over 1 300 young people had received such services.
During the development project focusing on rehabilitation services for NEETs, a total of 1 143 young persons received vocational rehabilitation services. A register-based follow-up study on the use of benefits and services before, during and after the development project is in progress at Kela.
Short Orals Session 16
Do diagnosis group play a role in associations between sickness absence and inpatient- and specialized outpatient care
A. Ropponen1, L. Mather1, M. Wang1, J. Narusyte1, S. Kärkkäinen1, V. Blom1, G. Bergström2, P. Svedberg1 (1Stockholm SE; 2Gävle SE)
Sickness absence (SA) is a common practice in health care. Consequences of SA have merited interest in recent years as the effects are considerable for the individual, employers and for society. The adverse effects of SA include medical (such as hospitalization), psychosocial (comorbidity or related to exclusion from labour market), but also economic (i.e. loss of income or extra costs) aspects. Until now, relatively few studies have investigated the consequences of various SA diagnosis groups.
To investigate associations between the main diagnosis groups of SA and subsequent inpatient- and specialized outpatient care.
Follow-up was based on the national registries included in the Swedish Twin project Of Disability pension and Sickness absence (STODS) from 2003 to 2013.The open cohort sample of twins was limited to those with a first incident SA due to musculoskeletal (ICD-10 M00-M99), mental (F00-F99) and other diagnoses, being alive and living in Sweden, and not having SA due to pregnancy related diagnoses (0 O00-O99), DP, or attendance to any patient care at baseline. Hence, the final sample consisted of 18,568 individuals of which 5,284 had in- or outpatient care during the follow-up. Mean age at SA was 39.5 years [range 16-79, standard deviation (SD) 12.0] and 61% were women. Cox proportional hazards regression models with covariates including familial factors (i.e. genetics and early shared environment) were utilized to calculate hazard ratios (HR) with 95% confidence intervals (CI).
The mean follow-up time was 5.6 years (range 0-11, SD 3.6 years). During the follow-up 2040 individuals from sample had been admitted to inpatient care whereas 3329 individuals to outpatient care. The main diagnoses for inpatient care were O00-O99 23%, M00-M99 11%, and S00-T98 10%, and for outpatient care M00-M99 17%, S00-T98 14%, and Z00-Z99 12%. Both SA due to mental diagnoses (HR 1.37, 95%CI 1.23, 1.50) and SA due to musculoskeletal diagnoses (HR 1.33. 95%CI 1.22, 1.45) showed increased risk of outpatient care in the models controlling for covariates and familial confounding compared to other diagnoses. Associations between SA and inpatient care attenuated to statistical non-significance when accounting for covariates.
These preliminary findings indicate that SA due to mental or musculoskeletal diagnoses predict outpatient care which should be considered for preventive measures in occupational or other care.
Impact on insurance medicine:
Consequences of SA merit attention since SA could be considered as a first indicator for preventive measures to improve health and work capacity.
Exploring “practice-based evidence” to maintain/regain employment for cancer-patients in Belgian oncology care
H. Désiron1, S. Décuman2, T. Simons3, T. Simons3, T. Brunois4, K. van Kelst2, T. Otte2, S. Camut2, S. Camut2, S. Camut2, D. van de Velde5, D. van de Velde5, A. Spooren3, L. Godderis6 (1hasselt BE; 2Brussel BE; 3Hasselt BE; 4brussel BE; 5Gent BE; 6Leuven BE)
For cancer-survivors at working age, labour-participation is part of their quality of life (QoL) and therefore an important element in care-services that aim to enhance QoL. A growing amount of scientific evidence emphasises on the importance of early administrated and hospital-based support of RTW in cancer-survivors. However, the implementation of available evidence and knowledge on RTW-focused practice in oncological healthcare seems to be very limited.
In order to develop a guideline on RTW in cancer-survivors in Belgium, this study inventories practice based evidence to understand what barriers hinder health-care professionals (HcP) to apply the available knowledge. HcP will also be asked about their needs to integrate RTW-oriented knowledge into their practice.
A scoping review was carried out to update literature that founded a Belgian mimic RCT on hospitalbased RTW-support for cancer-patients. The outcome was used to develop two qualitative studies: 1) in dept interviews with leaders of multidisciplinary teams in oncological care in Belgian hospitals (n = 79); 2) focus group-discussion with multidisciplinary groups of HcP involved in direct patient-contact with cancer survivors. Analyses of transcribed recordings of both studies will be realised by using Nvivo, with contribution of the members of the research-committee (all co-authors).
The analysis of the first study reveals on one hand the low focus on RTW in hospitals and on the other hand the provision of no cure-related additional services. The need for multidisciplinary team support is recognised but not realised due to lack of time, finances, knowledge, and specific (assessment-)instruments. Only one of the interviewees declared to use scientific evidence to develop additional care-services including RTW-support. The other interviewees mention that when cancer-survivors themselves have question on work-related issues, they look for specific answers (on case-by-case basis). Few hospitals provide some kind of RTW support (often delivered by volunteers or external organisations), but a great part of the interviewees indicate that they regret to be unable to do so in a systematic way. The second study’s focusgroup-discussions are planned in January 2020. Full results will be available in July 2020.
The identification of the barriers and facilitators that influence the way in which oncologic care-practice can or cannot integrate scientific evidence enables not only to set up policies that enhance hospital based quality of RTW-support. It creates a practice based foundation that will provide knowledge to construct the following steps of an implementable guideline.
Piloting the Health and Work Curriculum in Undergraduate Medical Education in England
F. Hashem1, S. Jaswal1, C. Marchand1 (1Canterbury GB)
We report on a project commissioned by the UK Government’s executive agency Public Health England (PHE) to develop and pilot a set of curriculum resources on health and work that were available to six medical schools in England. This project is underpinned by the 2018 Outcomes for Graduates developed by the UK’s General Medical Council (or GMC), which sets the standards for medical schools in the UK. It includes an expectation that newly qualified doctors will be able describe the principles of holding a fitness for work conversation with patients…and how to make referrals to colleagues and other agencies.
The aim of this project was to improve the health and work dialogue between doctors of the future and patients. The background to this work lies within the UK Government’s national vision to reduce health-related worklessness and help individuals achieve their work and health potential, which it set out in its command paper Improving Lives: the Future of Work, Health and Disability.
The purpose of the pilot was to answer the question, “Is it feasible to implement the teaching of health and work topics into the medical school curriculum?”
The overarching aim of the project was to design and pilot an integrated curriculum for future doctors that addresses how to communicate with service users/patients about staying in and returning to work.
Qualitative and quantitative methods were employed involving telephone interviews with course tutors prior to and following the teaching pilot, student surveys and focus groups in each of the six medical schools who took part in the pilot.
The results indicated: where aspects of the curriculum improved understanding of broaching health and work conversations; helped to recognise what factors facilitated further learning; what support and advice the tutors required to teach the materials, and where additional resources were needed to help deliver the teaching resources. Lastly, the results highlighted what some of the limitation were with introducing the health and work curriculum.
This pilot study showed it was possible to introduce a set of curriculum resources on health and work in English medical schools, with course tutors welcoming the opportunity of using a range of teaching materials aimed at undergraduate medical education.
Impact on insurance medicine practice
Total Worker Health: a framework for achieving well-being
Paul A. Schulte
Abstract: Well-being is an overarching construct to address the impact on workers of the changing nature of work, the workforce, and the workplace. Total Worker Health® merges health protection and health promotion and treats the wholeness of workers. The future of work requires that enhanced perspective. An expanded focus for the occupational safety and health professions will help achieve Total Worker Health.
Multimorbidity as a Challenge of the 21st century and its Impact for Rehabilitation
„What are the „real“ challenges of future medicine and health insurance?“
Professor Dr Joachim Breuer
Abstract: Future medicine and health insurance are facing undisputedly dramatic changes. It is thus no surprise that conferences are focussing on issues like digitalization, artificial intelligence, electronic health records or new technical options for treatments. But is this not just a view from the „inside“, too much concentrated of what medicine and doctors could and health insurance should do? Are there no (other) factors and (e.g. political) developments „outside of medicine“, which have a comparable or even higher impact on the future? The presentation seeks to give a different perspective of what is driving the future of medicine and the health insurance area.
Work disability prevention through interdisciplinary collaboration
Abstract: Work disability (WD) is a complex problem. Its prevention calls for multiple disciplinary approaches focusing on risks at population level (primary), on incipient work disability (secondary), and on return to work (tertiary prevention). In addition to the individual and workplace issues,risks related to health care and social security systems can delay return to work and even induce WD. In collaboration between various actors, the concept of WD should be clarified, as divergent emphases might hamper successful prevention. Solutions to service coordination, work modification and health-focused practices will be discussed togehter with proposals for improvement.