Abstract
BackgroundNationwide implementation of guaranteed access to evidence-based rehabilitation was established in Sweden in 2009, through an Act of the Swedish Government. The rehabilitation guarantee’s primary goal was to increase the rate of return-to-work, reduce and prevent long-term absenteeism after diagnoses related to back pain and common mental health problems. This study aims to develop knowledge about factors influencing large-scale implementation of complex and extensive interventions in healthcare settings.MethodsThree different data sources questionnaires, interviews and documents were used in data collection and analysis. The data were analysed using iterative thematic analysis.ResultsThe following main facilitators contributed to realization of the rehabilitation guarantee: financial incentives, establishment of project organization, recruitment, in-service training and previous experiences of working in similar projects. Barriers were: the rehabilitation guarantee’s short-term project-form, clinicians’ attitudes to and competence in working towards return-to-work, lack of guidelines describing treatment modalities in multimodal rehabilitation, and lack of well-defined criteria for inclusion of patients. Documents revealed that the return-to-work goal became less pronounced during the implementation process. Instead, care and health were more often described in documents used to disseminate information about the rehabilitation guarantee. Intermediate outcomes found were: patients with rehabilitation needs were given more adequate priority, increased readiness for future implementation efforts, and increased general competence in psychotherapy, and team-work, which thus became available to patient groups other than those covered by the rehabilitation guarantee.ConclusionsTo facilitate implementation of established national policy goals in clinical practice, tools are needed that specifically aim at changing clinicians’ attitudes and behaviours in relation to such goals. Our results underline the importance of investing both time and sufficient resources in the activities and in supporting the implementation process.
Highlights
Nationwide implementation of guaranteed access to evidence-based rehabilitation was established in Sweden in 2009, through an Act of the Swedish Government
The implementation was confirmed by four governing factors: (1) a financial incentive for county councils to participate in the rehabilitation guarantee (RG); (2) a political resolution between the Swedish Association of Local Authorities and Regions and the Swedish Government; (3) guidelines from the relevant authorities; and (4) and evidence-based knowledge forming the basis for what therapies were to be offered within the RG
The financial incentive coming from the national level was an overall facilitating factor for implementation at the county council management as well as the clinical level
Summary
Nationwide implementation of guaranteed access to evidence-based rehabilitation was established in Sweden in 2009, through an Act of the Swedish Government. The rehabilitation guarantee’s primary goal was to increase the rate of return-to-work, reduce and prevent long-term absenteeism after diagnoses related to back pain and common mental health problems. Diagnoses and evidence-based rehabilitation The lifetime prevalence of back, neck, and shoulder pain is estimated to be 70–80% in the general population [1]. These conditions are the greatest causes of work incapacity in Europe [2,3]. There is evidence that MMR reduces symptoms, disability, and absenteeism [6], that it is cost-effective [7] up to ten years after the intervention [8,9]
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