Abstract
BackgroundIt has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP’s objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient.Methods/designThe current study is a randomized controlled trial in a Norwegian primary care context, involving an effect evaluation, a cost/benefit analysis, and a qualitative evaluation. Independent medical evaluation will be compared to treatment as usual, i.e., the physicians’ and social insurance agencies’ current management of long-term sick-listed patients. Individuals aged 18–65 years, sick listed by their GP and on full or partial sick leave for the past 6 months in Hordaland county will be included. Exclusion criteria are pregnancy, cancer, dementia or an ICD-10 diagnosis. A total sample of 3800 will be randomly assigned to either independent medical evaluation or treatment as usual. Official register data will be used to measure the primary outcome; change in sickness benefits at 7, 9 and 12 months. Sick listed in other counties will serve as a second control group, if appropriate under the “common trend” assumption.DiscussionThe Norwegian effect evaluation of independent medical evaluation after 6 months sick leave is a large randomized controlled trial, and the first of its kind, to evaluate this type of intervention as a means of getting people back to work after long-term sickness absence.Trial registrationClinicalTrials.gov NCT02524392. Registered June 23, 2015.
Highlights
It has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP’s objective evaluation of need for sick leave
The majority of individuals with illness and disease do not need any assistance to return to work (RTW) after a period of sick leave [1, 2]
Work disability may lead to disability pension [3]
Summary
It has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP’s objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient. In Norway, 330 individuals reach 6 months of uninterrupted sick leave every day. For these individuals, work disability may lead to disability pension [3]. Amongst 15 OECD countries, Sweden and Norway had the highest percentage increase in people between 20 and 64 years on disability pension, from 1980 to 2007/2008 [4]. This is a negative trend, because very few return to work after having received disability pension [3]
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