Nationwide implementation of a national policy for evidence-based rehabilitation with focus on facilitating return to work: a survey of perceived use, facilitators, and barriers.

AIM: The aim is to assess whether the national policy for evidence-based rehabilitation with a focus on facilitating return-to-work is being implemented in health-care units in Sweden and which factors influence its implementation.

METHODS: A survey design was used to investigate the implementation. Data were collected at county council management level (process leaders) and clinical level (clinicians in primary and secondary care) using web surveys. Data were analyzed using SPSS, presented as descriptive statistics.

RESULTS: The response rate among the process leaders was 88% (n = 30). Twenty-eight percent reported that they had already introduced workplace interventions. A majority of the county councils' process leaders responded that the national policy was not clearly defined. The response rate among clinicians was 72% (n = 580). Few clinicians working with patients with common mental disorders or musculoskeletal disorders responded that they were in contact with a patient's employer, the occupational health services or the employment office (9-18%). Nearly, all clinicians responded that they often/always discuss work-related problems with their patients.

CONCLUSIONS: The policy had been implemented or was to be implemented before the end of 2015. Lack of clearly stated goals, training, and guidelines were, however, barriers to implementation. Implications for rehabilitation Clinicians' positive attitudes and willingness to discuss workplace interventions with their patients were important facilitators related to the implementation of a nationwide policy for workplace interventions/rehabilitation. A lack of clearly stated goals, training, and guidelines were barriers related to the implementation. The development of evidence-based policies regarding rehabilitation and its implementation has to rely on very structured and clear descriptions of what to do, preferably with the help of practice guidelines. Nationwide implementation of rehabilitation policies has to allow time for preparation including communication of goals and competence assurance in a close collaboration with the end users, namely clinicians and patients. Abbreviations CBT Cognitive behavioral therapy CFIR Consolidated framework for implementation research CMD Common mental disorders IPT Interpersonal psychotherapy MMR Multimodal rehabilitation RG Rehabilitation guarantee RTW Return to work SPSS Statistical package for the social sciences.