Abstract
BackgroundNorwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs’ expectations of and experiences with IMEs.MethodsWe conducted three focus group interviews with a convenience sample of 14 GPs who had had 2–9 (mean 5) of their long-term sick-listed patients summoned to an IME. We asked them to recollect and describe their concrete expectations of and experiences with patients assigned to an IME. Systematic text condensation, a method for thematic cross-case analysis, was applied for analysis.ResultsTo care for and to reassure their assigned sick-listed patients, the participants had spent time and applied different strategies before their patients had attended an IME. The participants welcomed a second opinion from an experienced GP colleague as a way of obtaining constructive advice for further sick-leave measures and/or medical advice. However, they mainly described the IME reports in negative terms, as these were either too categorical or provided unusable advice for further follow-up of their sick-listed patients. The participants did not agree with the proposed routine use of IMEs but instead suggested that GPs should be able to select particularly challenging sick-listed patients for an IME, which should be performed by a peer.ConclusionOur participants showed positive attitudes towards second opinions but found the regular IMEs to be unsuitable. The participants did however welcome IMEs if they themselves could select particularly challenging patients for a mandatory second opinion by a peer but emphasized that IME-doctors should not be able to overrule a GP’s sick-leave recommendation. These findings, together with other evaluations, will serve as a basis for the Norwegian government’s decision on whether or not to implement IMEs for long-term sick-listed patients.Trial registrationClinicalTrials.gov NCT02524392. Registered 23 June, 2015.
Highlights
Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave
Recruitment and sample We intended to select a purposive sample of GPs in terms of gender, work experience and a minimum number of three patients enrolled in the NIME trial
The participants’ reactions were mainly negative when they became aware that some Independent medical evaluation (IME) doctors in other countries are not GPs but have other specializations such as orthopedic surgeons
Summary
Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs’ expectations of and experiences with IMEs. The Norwegian government is seeking new strategies to lower the country’s sick-leave rate, which currently is at 6.4% [1] and claimed to be among Europe’s highest [2]. Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave [3]. When promoting return to work (RTW) among their sick-listed patients, GPs describe challenges with assessing work ability, the percentage of functional work-capacity and the length of sick-leave periods [4, 5]. Denying a patient’s request for sick-leave might come at a high price, for instance the patient might change her GP, and terminate a close doctor-patient relationship which may have a strong emotional impact on GPs [6]
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