title: Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care.
abstract: In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care.
  
  
  
  This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied.
  
  
  
  PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%.
  
  
  
  We found that referral rates to MMR were positively associated with PHCCs located in medium and large sized communities with higher socioeconomic status among the registered population, private PHCCs and PHCCs providing their own MMR. Patients with MSD are thus facing significant inequities and were thus not offered the same opportunities for referrals to rehabilitation regardless of which PHCC they visited.
authors.affiliation: Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden. charlotte.sennehed@kronoberg.se.|Epidemiology and Register Centre South, Region Skåne, Lund, Sweden. charlotte.sennehed@kronoberg.se.|Department of Research and Development, Region Kronoberg, Växjö, Sweden. charlotte.sennehed@kronoberg.se.
authors.forename: Charlotte Post
authors.initials: CP
authors.lastname: Sennehed
authors.affiliation: Department of Research and Development, Region Kronoberg, Växjö, Sweden.|Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Holmberg
authors.affiliation: Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.|Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden.
authors.forename: Kjerstin
authors.initials: K
authors.lastname: Stigmar
authors.affiliation: Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.|Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.|Blekinge Centre of Competence, Karlskrona, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Forsbrand
authors.affiliation: Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.|Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.
authors.forename: Ingemar F
authors.initials: IF
authors.lastname: Petersson
authors.affiliation: Skåne Regional Council, Region Skåne, Department of Healthcare Governance, Malmö, Sweden.
authors.forename: Anja
authors.initials: A
authors.lastname: Nyberg
authors.affiliation: Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.|Epidemiology and Register Centre South, Region Skåne, Lund, Sweden.|Department of Research and Development, Region Kronoberg, Växjö, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Grahn
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006282:Health Personnel; D006801:Humans; D016014:Linear Models; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D013548:Sweden
keywords: Multiprofessional rehabilitation; Musculoskeletal disorders; Primary health care; Referral rate