147 Context analysis of interventions among lower socioeconomic position employees difficult to solve problems (23). Hence, this group of employees needs support to break this cycle, but it remains uncertain whether all problems on multiple life domains can be addressed at the workplace. Findings of this study showed that responsibilities of all stakeholders involved to solve problems on multiple life domains are considered unclear. In the Netherlands, occupational healthcare is operating by law in a private market and strongly depends on the contract between an OHS and employer. OHSs are often commercial organizations and they do not feel the responsibility to solve problems on other life domains than work. In the end, employers determine the intensity and focus of services provided by the OHS, which may be a barrier for preventive interventions that consider multiple life domains. Although there are some legal obligations for employers, stakeholders in this study described that employers mainly focus on the guidance of employees on sick leave and to a lesser extent on the prevention of sick leave. Moreover, it is evident that not all employers feel responsible and are willing to pay for solving all kinds of problems preventively. This may, to some extent, also apply to other countries, because international studies show that the in the majority of the countries OHSs are paid mainly or only by employers (24, 25). Stakeholders in this study representing GPs and OPs also mentioned that they do not feel responsible to solve problems on multiple life domains. In the Netherlands, occupational and curative healthcare are strictly separated. This provides employees two options to discuss their health complaints, but a connection between occupational and curative healthcare to collaborate is missing. The financial systems of occupational and curative healthcare are also separated in the Netherlands, which may further discourage collaboration. In contrast, occupational and curative healthcare are not strictly separated in other European countries, such as Finland and Germany (26). In these countries, OPs and GPs are often the same person or both OPs and GPs can perform occupational and curative tasks. For example, in Finland occupational health services are important providers of curative healthcare. Finnish OPs partly act as GPs for employees, about half of the GP visits takes place within occupational healthcare and almost all visits to an OP were for primary care advice (27). Hence, to provide adequate care to employees, European countries, such as Finland and Germany, are less dependent on collaboration between occupational and curative healthcare. Unfortunately, in the Netherlands adequate care for employees is highly dependent on collaboration between occupational and curative healthcare. Collaboration between GPs and OPs in general is not optimal (28, 29), and this is also a problem in countries where GPs are certified to give advice on sick leave (30,31,32). Although, GPs are often the first health professional for employees to discuss health complaints, they are reluctant to discuss work-related problems, due to a lack of expertise and time (26, 28, 33). Moreover, GPs express reluctance to contact an OP due to a lack of confidence in the independence of OPs and 5
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