The extent to which medical specialists provide Clinical Work-Integrating Care (CWIC) and their perceived role-responsibility: a mixed-methods study.

Abstract

Background: Awareness among medical specialists about patient work concerns is important because work and health are linked. In Clinical Work-Integrating Care (CWIC), specialists adopt the notion that work can affect health, and medical actions can affect work participation, and they act according to that notion. This study aims to assess the extent to which specialists provide CWIC and to obtain perceptions of medical specialists about their professional role-responsibility in providing CWIC.

Methods: This cross-sectional mixed-methods study involved quantitative questionnaires and qualitative interviews with medical specialists. The self-developed 18-item questionnaire evaluated the extent and type of CWIC provision (rating scale 0-4; Never = 0 to Always = 4) and how role-responsibility was perceived, while the interviews offered more in-depth insights. Descriptive statistics for the questionnaire data and thematic analyses for the interview data were applied.

Results: We attained 160 questionnaires (female 64%, 93% non-surgical specialists) and 11 interviews (female 64%, 91% non-surgical specialists). Specialists often asked patients about work (mean score 3.1), sometimes about work history (mean score 2.2) and the conversation about work was usually started by the specialist (mean score 2.9). Conversations about work often concerned the influence of work on disease (2.4) and the influence of disease (2.5) or treatment (2.1) on work ability, but rarely about the legal aspects related to sick leave (1.5). The specialists' perceived role-responsibility was summarized in three themes: 1) understanding that work and health (problems) are linked including asking patients about work and investigating work factors, 2) supporting work participation within a specialist's expertise including focus on patients' health and prevention of sick leave, and 3) possibilities and limitations of the healthcare system including work participation as treatment goal and cooperation with occupational health care.

Conclusions: Medical specialists in our survey usually asked about patients' work, but they often did not take a work history. Limitations within the healthcare system hinder comprehensive work-integrating support by specialists, defining the boundaries of CWIC to within hospital care.