title: Cooperation between gatekeepers in sickness insurance - the perspective of social insurance officers. A qualitative study.
abstract: BACKGROUND
  Objective was to describe variations in how social insurance officers conceive the cooperation with the health care in their daily work with sick leave.
  
  
  METHODS
  Fifteen social insurance officers (SIOs) working with administration of sickness benefits were interviewed. They were purposefully recruited to represent different parts of the social insurance office organization, different ages, gender, education, and work experience. The interviews were audio-recorded, transcribed verbatim and analyzed using phenomenographic approach.
  
  
  RESULTS
  11 women and 4 men, aged 25-65, with a work experience ranging from 1-40 years were interviewed. Three descriptive categories embracing eleven subcategories emerged: 1) Communication channels included three subcategories; to obtain medical opinions, to hold meetings with actors involved, to experience support functions; 2) Organizational conditions included five subcategories; to experience lack of time, to experience problems of availability, to experience lack of continuity, to experience unclear responsibility, to experience ongoing change; 3) Attitudes included three subcategories; to conceive the attitudes of the physicians, to conceive the attitudes of the patients, to conceive the attitudes of the SIOs.
  
  
  CONCLUSIONS
  Personal communication was described as crucial to ensure a more efficient working process. The personal contact was obstructed mainly by issues related to work load, lack of continuity, and reorganisations. By enhancing and enabling personal contact between SIOs and health care professionals, the waiting times for the sick-listed might be shortened, resulting in shorter periods of sick-leave. Issues around collaboration and communication between gatekeepers need to be recognized in the ongoing work with new guidelines and education in insurance medicine.
authors.affiliation: The MORSE project Musculoskeletal Research Centre, Department of Orthopedics, University Hospital, Lund, Sweden. carina.thorstensson@spenshult.se
authors.forename: Carina A
authors.initials: CA
authors.lastname: Thorstensson
authors.forename: Jenny
authors.initials: J
authors.lastname: Mathiasson
authors.forename: Barbro
authors.initials: B
authors.lastname: Arvidsson
authors.forename: Anders
authors.initials: A
authors.lastname: Heide
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
mesh_terms: D000328:Adult; D001290:Attitude; D002568:Certification / Q000379:methods*; D003299:Cooperative Behavior; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D020793:Gatekeeping / Q000458:organization & administration*; D006126:Group Processes; D006801:Humans; D018868:Insurance, Disability / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D007858:Learning; D008297:Male; D008875:Middle Aged; D009787:Occupational Medicine / Q000193:education / Q000458:organization & administration; D017064:Process Assessment, Health Care; D011594:Psychometrics; D036301:Qualitative Research; D018582:Sick Leave; D013548:Sweden; D014938:Work Capacity Evaluation