Care manager organisation in Swedish primary care centres: impact of sick leave and sick leave duration in patients with common mental disorders. A register-based study.

Motivation: Primary care centres are the first line of mental health service in Sweden responsible for individuals with mild to moderate severe symptoms of common mental disorders (CMD). The aim was to evaluate impact of sick leave and sick leave duration in patients diagnosed with CMD in primary care centres with a care manager organisation during the first and second year after implementation compared to usual care.

Methods: Register data on sick leave (mean number of net and gross sick leave days) among patients with CMD was obtained per primary care centre from the national social insurance database MiDAS. Two measures of sick leave were used: impact of sick leave in total patient population with CMD, and sick leave duration among sick listed patients with CMD. Linear mixed-effects regression analysis was performed for cross-sectional differences and longitudinal changes between and within the two groups of primary care centres.

Results: Primary care centres with care as usual had a lower proportion of sick listed patients with CMD at both year 1 and 2. Primary care centres with a care manager organisation (CMO) had significantly fewer mean number of sick leave days (net and gross days) among patients with CMD compared to centres with care as usual, indicating a lower impact of sick leave. Sick leave duration among sick listed patients did not show statistically significant differences between the two groups of primary care centres. Both groups of primary care centres increased their sick leave duration significantly from year 1 to year 2, congruent to Sweden as a whole.

Conclusion: The aim of this study was to evaluate two measures of sick leave in primary care centres with a care manager organisation compared to care as usual. There were no differences in sick leave duration. Primary care centres with a care manager organisation, designed to increase accessibility and continuity for patients with CMD, seemed to facilitate the primary care centre's possibility to offer enhanced care taking to more patients with CMD with continued lower levels of impact of sick leave compared to care as usual.

Implementation: This study evaluated outcomes after implementation of CMO at primary care centres.