Study setting and context
CMD, diabetic, diabetes
DIABETES
As described above, an implementation of the care manager function at interested PCCs has been ongoing since 2015 in the Region Västra Götaland, Sweden (inhabitants ~1.7 million; ~200 PCCs). The first part of the implementation was conducted as an RCT (ClinicalTrials.gov Identifier: NCT02378272).In Sweden, primary care is organised in PCCs, which (besides several GPs) also have specially educated nurses, primary care psychologists, counsellors and physiotherapists, often working in team around the patient. The PCCs serve around 2000–30 000 listed patients (around 1 GP and 2 nurses per 2000 listed). All PCCs have, for example, a specially educated nurse who works part time with diabetes patient care together with the GP, preferably via individually adjusted health promotion activities, while also guaranteeing accessibility and continuity for the diabetic patient. In a similar manner, the care manager’s assignment is to work part time with CMD patients to guarantee accessibility and continuity for the CMD patient and promote psychopedagogical support to the patient during the illness. A care manager academic education, financed via the Region Västra Götaland county council, is mandatory (Care Manager for CMD, 7.5 higher education credits).During the same time as the care manager organisation was implemented, an implementation of a function to coordinate the sick leave and rehabilitation process, that is, a rehabilitation coordinator, was also carried out at all PCCs in the region. A rehabilitation coordinator was initiated in 2016 via a national project with special governmental funding to the regions to offer coordinating work to patients on sick leave to promote RTW. A rehabilitation coordinator has an education in social insurance laws and regulations and vocational rehabilitation and serves as a regulation knowledge broker for the PCCs and a support for the patient’s RTW process and workplace cooperation. The education standards vary between regions and organisations. In primary care, the rehabilitation coordinator often serves several PCCs in contrast to care managers who are part of the PCCs’ ordinary personnel and working part of their duty as care managers. At some PCCs enrolled in this trial (11/28=39%; 5/14 intervention PCCs, 6/14 control PCCs) the care manager also served as rehabilitation coordinator.