Co-financed collaboration between welfare services. Effects on staff and patients with musculoskeletal disorders

Abstract

Background: The number of individuals in need of help and support simultaneously fromdifferent welfare services has increased. Collaboration between professionals and authoritieshas been seen as a way to improve the efficiency in treatment and rehabilitation. In Sweden,a trial legislation called SOCSAM was introduced in 1994 with an aim to improvecollaboration and decrease costs for society through allowing co-financing and joint politicalsteering across welfare services.Aim: The main aim of this thesis was to assess if co-financed collaboration between primaryhealth care, the social (sickness) insurance offices and social services contributed toimproved care and rehabilitation for people with musculoskeletal disorders.Methods: This research project assessed the effects of a natural experiment. Patients withmusculoskeletal disorders attending three health centres with co-financed collaboration(DELTA health centres) were compared to similar patients attending four control healthcentres not practicing collaboration under the trial legislation. One hundred thirty eightpatients were followed prospectively for one year. Information about health status, healthcare contacts and sick leave were collected through patients interviews, through medicalrecords, through the Swedish Social Insurance Registry, and through patient diaries. Theproject also involved a comparative qualitative study on staff-perceptions of the collaborativestructure in DELTA and control health centres.Results: Staff in both DELTA and control health centres reported fairly well functioninginternal collaboration, but only staff at DELTA health centres reported well-functioningcollaboration with social insurance offices. There were no major differences in baselinecharacteristics between the two patient groups. No significant differences between patientsin the DELTA centres and the controls concerning change in health status between baselineand 12 months follow-up were found. Mean number of sick leave days during the 12-months period after inclusion was 94 for the DELTA patients and 87 for controls. At 12months follow up, 31% in the DELTA group and 32% in the control group were on sickleave. Patients in the DELTA health centres had more contacts with physiotherapists thanthe controls, especially during the first months after inclusion. Contacts with socialinsurance office, social services or hospital did not differ significantly between the groups.The type of treatment the patient received only differed slightly between the groups.Conclusion: Staff involved in the co-financed collaboration under SOCSAM perceived thatthe model was important for the collaborative process and that it had stimulated newinterdisciplinary team structures. However, the follow-up studies of patients indicated thatthere were no major differences in the care and rehabilitation approaches, or treatmentsreceived, between DELTA and control patients. The only clear difference was that DELTApatients received more physiotherapy than controls. There is a weak evidence base for thetype of treatments that was received by patients in both groups, which may explain why nosignificant differences were observed concerning health outcome or sick leave. The studieshad some methodological limitations. Since the sample size was small and an observationaldesign was used, the data should be interpreted with caution. Results may not begeneralisable beyond rehabilitation of people with musculoskeletal disorders. This researchcontributes a small part only of the data required to judge the overall effects of co-financedcollaboration under SOCSAM.