Factors affecting patients' journey with primary healthcare services during mental health-related sick leave.

CONTEXT: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice-related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. OBJECTIVE AND POPULATION STUDIED: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. METHODS: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. RESULTS: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. CONCLUSIONS: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health-related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. PATIENTS OF PUBLIC CONTRIBUTION: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population.

Feasibility evaluation of a return-to-work program for workers with common mental disorders: Stakeholders' perspectives.

OBJECTIVE: This study aimed to evaluate the feasibility of a newly developed return-to-work program for workers with common mental disorders from the perspective of stakeholders (insurers, employers, unions, and workers). METHODS: We used a sequential mixed design. First, we conducted a survey to evaluate the levels of stakeholder agreement with the program's feasibility. Second, we conducted a number of independent, homogeneous-group discussions or individual interviews to deepen stakeholders' reflections and allow co-construction of a shared perspective of the program's feasibility. RESULTS: Overall, the stakeholders (insurers (n = 6), employers (n = 7), unions (n = 8), and workers (n = 3)), agreed partly to totally with the feasibility of the specific/intermediate objectives, components/tasks, and duration of the components. They identified obstacles that could hinder program implementation. These obstacles pertained mainly to employers' contexts, e.g., difficulty/impossibility of offering job accommodations. They also proposed facilitators to counteract most of these obstacles. Diverging views were found regarding both the role of union representatives and health professionals in the program, and for the duration of the components. CONCLUSION: Overall, the program was perceived as feasible to implement, provided that the potential factors discussed are taken into account. The next step will be to evaluate its implementation in real practice settings.

Logic models for the Therapeutic Return-to-Work Program as adapted for common mental disorders: A guide for health professionals.

BACKGROUND: Workplace interventions are recommended for workers with common mental disorders, but knowledge of their action mechanisms and operationalization remains limited. The Therapeutic Return-to-Work Program, developed for workers with musculoskeletal disorders, is recommended for common mental disorders. OBJECTIVE: Our objective was to adapt this program's logic models to common mental disorders. METHODS: A program logic analysis was conducted using a literature review and a two-phase group consensus method. We submitted a preliminary adapted version of the program's logic models and two questionnaires to health professional experts who participated in two group sessions, ultimately to produce the final version of the models. RESULTS: We consulted 86 publications. The health professional experts (N = 7) had overall mean agreement scores of respectively 4.10/5 and 3.89/5 for questions on the program's theoretical and operational models. The final version of the logic models adapted for common mental disorders included four specific and 15 intermediate objectives, three main components, one optional component, four key processes, and 44 tasks. CONCLUSION: The adapted logic models for the Therapeutic Return-to-Work Program show the relevance of the original objectives and components for common mental disorders. The next step will involve evaluating its feasibility with other stakeholders (insurers, employers, unions, workers).

Does participation in interdisciplinary work rehabilitation programme influence return to work obstacles and predictive factors?

PURPOSE: Musculoskeletal disorders evolve into long-term work disabilities in--10% of work-injury cases. From a prevention perspective, screening for predictive factors and obstacles associated with long-term work disability appear to offer a promising avenue for work rehabilitation. However, knowledge of the factors at play during the chronic phase remains limited. This study aims to explore the presence of a relationship between the predictive factors and obstacles identified at the time of admission to an interdisciplinary work rehabilitation programme and return to work upon completion of the programme, in individuals with a long-term work disability. METHOD: A descriptive correlational study involving 222 individuals assessed using the Work Disability Diagnostic Interview and who participated in the PREVICAP work rehabilitation programme. RESULTS: The general model accurately predicts the work status of 77% of the participants. Seven to nine factors were found to be associated with return to work in each model produced (3). Those factors were mainly psychosocial and work-related in nature and differ according to gender. Unexpectedly, certain obstacles observed at the time of admission to the programme appear to have a protective effect and thus promote participants' return to work. CONCLUSION: The results obtained support the hypothesis that screening for predictive factors and obstacles at the time of admission of a work rehabilitation programme for individuals with a long-term work disability allows for more effective intervention regarding these factors, and in all likelihood, promotes return to work.