Independent medical evaluation for sick-listed patients: a focus group study of GPs´ expectations and experiences

Abstract

Background: Norwegian general practitioners (GPs) are important stakeholders because they manage 80% of people on long-term sick-leave. Independent medical evaluation (IME) for long-term sick-listed patients is being evaluated in a large randomized controlled trial in one county in Norway in an effort to lower the national sick-leave rate (the NIME trial: Effect Evaluation of IME in Norway). The aim of the current study was to explore GPs' expectations of and experiences with IMEs.

Methods: We conducted three focus group interviews with a convenience sample of 14 GPs who had had 2-9 (mean 5) of their long-term sick-listed patients summoned to an IME. We asked them to recollect and describe their concrete expectations of and experiences with patients assigned to an IME. Systematic text condensation, a method for thematic cross-case analysis, was applied for analysis.

Results: To care for and to reassure their assigned sick-listed patients, the participants had spent time and applied different strategies before their patients had attended an IME. The participants welcomed a second opinion from an experienced GP colleague as a way of obtaining constructive advice for further sick-leave measures and/or medical advice. However, they mainly described the IME reports in negative terms, as these were either too categorical or provided unusable advice for further follow-up of their sick-listed patients. The participants did not agree with the proposed routine use of IMEs but instead suggested that GPs should be able to select particularly challenging sick-listed patients for an IME, which should be performed by a peer.

Conclusion: Our participants showed positive attitudes towards second opinions but found the regular IMEs to be unsuitable. The participants did however welcome IMEs if they themselves could select particularly challenging patients for a mandatory second opinion by a peer but emphasized that IME-doctors should not be able to overrule a GP's sick-leave recommendation. These findings, together with other evaluations, will serve as a basis for the Norwegian government's decision on whether or not to implement IMEs for long-term sick-listed patients.

Trial registration: ClinicalTrials.gov NCT02524392 . Registered 23 June, 2015.

Keywords: Focus groups; General practice; Independent medical evaluation; Qualitative research; Sick-leave.

Conflict of interest statement

Authors’ information

AA is a senior researcher at the Research Unit for General Practice in Bergen and also works as a GP in the southern part of Norway. EH is a clinical psychologist, project co-ordinator at Uni Research Health, and a PhD student at Haukeland University Hospital. SM is a senior researcher at Uni Research Health, associate professor at Western Norway University of Applied Sciences, Department of Health and Social Sciences, and has additional clinical work experience as a physiotherapist.

Ethics approval and consent to participate

The participants presented their experiences without revealing identifiable information about patients. The Regional Committee for Ethics in Medical Research assessed the study to be outside of their mandate (2015/560). The Norwegian Social Science Data Services approved the study (45866). The work has been carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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