How People with Multimorbidity and Psychosocial Difficulties Experience Support by Rehabilitation Coordinators During Sickness Absence

Veronica Svärd; Emilie Friberg; Azadé Azad

doi:10.2147/JMDH.S308840

How People with Multimorbidity and Psychosocial Difficulties Experience Support by Rehabilitation Coordinators During Sickness Absence

J Multidiscip Healthc. 2021 May 31:14:1245-1257. doi: 10.2147/JMDH.S308840. eCollection 2021.

Authors

Veronica Svärd^{1

2

3}, Emilie Friberg¹, Azadé Azad^{1

4}

Affiliations

¹ Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden.
² Department of Social Work in Health, Karolinska University Hospital, Stockholm, SE-171 76, Sweden.
³ Department of Social Work, Södertörn University, Huddinge, SE-141 89, Sweden.
⁴ Department of Psychology, Stockholm University, Stockholm, SE-114 19, Sweden.

Abstract

Purpose: People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators' support is perceived to be of importance.

Methods: Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context.

Results: The participants experienced problems in all domains of the model, namely: "the healthcare system", "the labor market and the workplace system", "the sickness insurance system", and "the personal system". Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes.

Conclusion: People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual's circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.

Keywords: coordination; multimorbidity; psychosocial difficulties; rehabilitation; return-to-work; sickness absence; social complexity.

Grants and funding

This research was financially supported by grants from The Kamprad Family Foundation for Research (Reference No 20190271). The funding body had no role in the design, execution, interpretation, or writing of the study.