Active sick leave for @entity1 with XXXX : all the players onside, but still no action.

@entity1 @entity615 @entity1643 @entity3457
STUDY DESIGN: Semistructured interviews, group discussions, and a mailed survey. OBJECTIVE: To identify barriers to the use of @entity3457 ( @entity3457 ) and to design an intervention to improve the use of @entity3457 by @entity1 with @entity1643 . SUMMARY OF BACKGROUND DATA: @entity3457 was introduced in Norway in 1993 to encourage @entity1 on sick leave to return to modified work. With @entity3457 the National Insurance Administration (NIA) pays 100% of wages, thereby allowing the employer to engage a substitute worker at no extra cost, in addition to the worker on @entity3457 . Arranging @entity3457 requires cooperation between the general practitioner (GP), employer, local NIA staff, and the @entity1 , which may explain why @entity3457 was used in less than 1% of the eligible sick leave cases in 1995, despite strong support from all players. METHODS: The authors conducted five in-depth interviews at a workplace where @entity3457 was successfully implemented. Questionnaires were sent to 89 GPs, 102 workplace representatives, and 22 local NIA officers in three counties. Five @entity1 with @entity615 who had used @entity3457 were interviewed in a focus group, and 10 @entity1 with @entity615 who had not used @entity3457 were interviewed using a structured guide. Five workplaces participated in a dialogue conference. Data collection and analysis were iterative, and new data were constantly compared with the previously analyzed materials. RESULTS: About 80% of the GPs, employers, and NIA officers believed @entity3457 is effective in reducing long-term sick leave. Among the barriers identified were lack of information, lack of time, and work flow barriers such as poor communication and coordination of activities between the players required to carry out @entity3457 . Two strategies were designed to improve the workflow between them. A passive implementation strategy was designed to require a minimum amount of economic and administrative support. It included targeted information, clinical guidelines for @entity1643 , a reminder to GPs in the sick leave form, and a standardized agreement. A proactive strategy included the same four elements plus a kick-off continuing education seminar for GPs and a trained resource @entity1 to facilitate the use of @entity3457 . CONCLUSIONS: Having all the players onside may be essential, but it is not sufficient to bring about action in workplace strategies for @entity1 with @entity1643 . If early return to modified work is effective, implementing it may require interventions targeted at identified barriers.
