Presentation T O14

T O14 (Oral Presentation):
Contextual analysis of Quebec general practitioners’ practices with a view to preventing long-term work disability related to depressive disorders

Presented by: Chantal Sylvain

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Sylvain C1,2, Durand MJ1,2, Lamothe L3,4, Quesnel L5, Maillette P1,2

  1. School of Rehabilitation, Universite de Sherbrooke, Sherbrooke, Canada
  2. Centre for Action in Work Disability Prevention and Rehabilitation, Longueuil, Canada
  3. Department of Health Administration, Universite de Montreal, Canada
  4. Public Health Research Institute of the Universite de Montreal, Montreal, Canada
  5. Agence de la sante et des services sociaux de la Monteregie, Longueuil, Canada



In recent years, depression has become one of the leading causes of work absenteeism. The medico-administrative system in Quebec (Canada) gives general practitioners (GPs) the responsibility for certifying sick leave and determining return-to-work (RTW) conditions. As such, they are at the heart of interaction among systems with often-diverging perspectives on RTW. Very few studies to date have investigated GPs’ practices in this context, or the conditions possibly hindering or facilitating their participation in concerted action. Our study fills these gaps.


Multiple-case study was begun in 2013. Two cases were selected in one region in Quebec. Data was collected from two sources (GPs, other health professionals involved in follow-up) through semi-structured interviews. Case-by-case data analysis is underway.


Four main findings emerge from preliminary analysis. 1) GPs do not automatically offer sick leave to patients with depressive symptoms. Their decision in this regard depends instead on what they consider most beneficial for the patient’s overall recovery. 2) Disparities exist in terms of timely access to specialized services (psychotherapy, psychiatry), which, for GPs, place a major limitation on their ability to effectively prevent long-term work disability. 3) When other health professionals are also involved in patient follow-up, direct contacts between them and GPs remain the exception rather than the rule. While GPs express clear concern about the need for coherence between their messages and actions and those of other service providers, this concern usually translates into and is limited to no more than asking their patients for their perceptions. 4) The insurer appears to play several roles, some deemed beneficial by GPs: a facilitating role, by providing faster access to otherwise hard-to-access specialized services; a structuring role, by setting limits on the maximum sick leave allowable prior to the RTW; a leveraging role, by encouraging patients to become active in preparation for their RTW.


In a public health system such as Quebec’s, preventing long-term disability necessarily requires concern about health services organization in general. Yet our results indicate that the current system does little to support joint action and even less to support links with the workplace, leaving GPs unable to optimize their interventions with this clientele.

Schedule Details

Tuesday September 30
13:45 - 15:15 Afternoon Concurrent Sessions (T O13 - T O24 and Seminar 5)
Session: Work Disability in workers with mental disorders
Room B