How do general practitioners contribute to preventing long-term work disability of their patients suffering from depressive disorders? A qualitative study.
Depression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs' practices with people experiencing work disability due to depressive disorders and explore how GPs' work context may impact on their practices.



We conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs' practices and highlight impacting factors in their work context.



Our results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs.



Our results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.
School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada. chantal.sylvain@usherbrooke.ca.|Centre for Action in Work Disability Prevention and Rehabilitation, Longueuil Campus, Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada. chantal.sylvain@usherbrooke.ca.
Chantal
C
Sylvain
School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.|Centre for Action in Work Disability Prevention and Rehabilitation, Longueuil Campus, Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada.
Marie-José
MJ
Durand
School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.|Centre for Action in Work Disability Prevention and Rehabilitation, Longueuil Campus, Université de Sherbrooke, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada.
Pascale
P
Maillette
Department of Health Administration, School of Public Health, Université de Montréal, Montréal, Canada.|Public Health Research Institute of Université de Montreal, C.P. 6128, Succursale Centre-ville, Montreal, QC, H3C 3J7, Canada.
Lise
L
Lamothe
D000041:Absenteeism; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy*; D005260:Female; D058006:General Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D010347:Patient Care Planning; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011568:Psychiatric Nursing; D036301:Qualitative Research; D011792:Quebec; D062707:Return to Work; D018582:Sick Leave; D000078329:Workforce; D017132:Workplace / Q000523:psychology
Depression; Doctor-patient relationship; Family practice; General practice; Long-term work disability; Mental health; Primary care; Return to work; Sick leave; Sickness certification