Sick leave prescription for workers with low back pain: results of a qualitative study
Dr Martine MORVANa, Dr Laurence PAPINAUDb, Mrs Aurélie BONCHEc, Mr Christian FATOUXc, Prof Emmanuel COUDEYREd, Prof Arnaud DUPEYRONe
a ELSM, CPAM Gard, b DRSM, Languedoc-Roussillon, c CPAM Gard, d CHU Clermont-Ferrand, e CHU Nîmes
Sick leave for low back pain (LBP) is an important public health problem with both social, economic and health related consequences. Remaining in work or returning quickly to work limit the potentially negative effects of long term sickness absence . The major determinants of sickleave prescription for LBP are not available in France. The aim of this work was to define how and why physicians prescribe sick leave for LBP workers.
Twelve items semi-structured interviews were undertaken with 80 physicians (general practitioners, rhumatologists, occupational theapists and medical adviser) during 6 focus group sessions. The interviews were recorded and transcribed verbatim. The transcripts were coded and analysed using content analysis.
Two main themes emerged including the doctor-patient relationship and the care pathway. Two sub-theme were necessary to classify all the verbatims with i) the "determinants of the medical consultation "including clinical data, professional practices and beliefs of physicians, the demands of the patient; ii) the « reason for work absence » that can meet the socio-professional context, clinical factors or technical and professional needs (imagery, expert advice)
Determinants of sick leave prescription are multifactorial and involve many areas (knowledge, professional practice, relational, coordination, regulatory) explaining the large interindividual variability of prescriptions among the different doctors interviewed. The solutions do not seem to only depend on the need of information and training of doctors.
The prescription of sick leave related to acute or chronic low back pain is influenced by many factors explaining i) the variability in patterns and leave times, ii) the low possibility of change for physician, iii) the definition of new tracks action.
1. van Tulder M, Koes B, Bombardier C: Low back pain. Best Pract Res Clin Rheumatol 2002, 16:761-765
Keywords : Low back pain, sick leave, qualitative design