Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden (original) (raw)
Related papers
Family Practice, 2016
Background. Challenges related to work are in focus when employed people with common mental disorders (CMDs) consult their GPs. Many become sickness certified and remain on sick leave over time. Objectives. To investigate the frequency of new CMD episodes among employed patients in Norwegian general practice and subsequent sickness certification. Methods. Using a national claims register, employed persons with a new episode of CMD were included. Sickness certification, sick leave over 16 days and length of absences were identified. Patient-and GP-related predictors for the different outcomes were assessed by means of logistic regression. Results. During 1 year 2.6% of employed men and 4.2% of employed women consulted their GP with a new episode of CMD. Forty-five percent were sickness certified, and 24 percent were absent over 16 days. Thirty-eight percent had depression and 19% acute stress reaction, which carried the highest risk for initial sickness certification, 75%, though not for prolonged absence. Men and older patients had lower risk for sickness certification, but higher risk for long-term absence. Conclusion. Better knowledge of factors at the workplace detrimental to mental health, and better treatment for depression and stress reactions might contribute to timely return of sickness absentees.
Primary health care research & development, 2011
Although mental illness remains the leading cause of both sickness absence and incapacity benefit in most high-income countries, little is known about how frequently patients with mental ill-health receive sickness certificates and what conditions are most commonly certified for. This study aims to use general practice consultation data to determine the rate of sickness certification for common mental health problems.
BMC Health Services Research, 2012
Background: Many psychiatrists are involved in sickness certification of their patients; however, there is very limited knowledge about this aspect of their work. The objective of this study was to explore frequencies of problematic issues in the sickness certification tasks and experiences of severity regarding these problematic issues among psychiatrists. Methods: A cross-sectional nationwide questionnaire study to all physicians in Sweden. The 579 specialists in psychiatry who answered the questionnaire, were under 65 years of age, worked mainly in psychiatric care, and had consultations involving sickness certification at least once a week were included. Results: The frequency of problematic sickness certification consultations a few times per year or more often was considered by 87.3% of the psychiatrists; 11.7% handle such cases at least once a week. A majority (60.9%) reported 'not having enough time with the patient' at least once a week. The psychiatrists had access to several categories of professionals in their daily work. More than one third certified unnecessarily long sick-leave periods at least once a month due to waiting times for Social Insurance Office investigations or for treatments or investigations within health care. Conclusion: The majority found it problematic to assess the level and duration of work incapacity, but also other types of problems like unnecessarily long sick-leave periods due to different types of waiting times. The findings have implications for different kinds of organisational and managerial support and training in sickness certification issues, like guidance to assess the level and duration of work incapacity.
A powerful intervention: general practitioners'; use of sickness certification in depression
BMC Family Practice, 2012
Background: Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression. Methods: A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009.
Sickness certification for common mental disorders and GP return-to-work advice
Primary Health Care Research & Development, 2016
AimTo report the types and duration of sickness certification for different common mental disorders (CMDs) and the prevalence of GP advice aimed at returning the patient to work.BackgroundIn the United Kingdom, common mental health problems, such and depression and stress, have become the main reasons for patients requesting a sickness certificate to abstain from usual employment. Increasing attention is being paid to mental health and its impact on employability and work capacity in all parts of the welfare system. However, relatively little is known about the extent to which different mental health diagnoses impact upon sickness certification outcomes, and how the GP has used the new fit note (introduced in 2010) to support a return to work for patients with mental health diagnoses.MethodsSickness certification data was collected from 68 UK-based general practices for a period of 12 months.FindingsThe study found a large part of all sickness absence certified by GPs was due to CMD...
BMJ Open, 2021
Objectives: To explore physicians’ experiences of using the national sickness certification guidelines introduced in 2007 and the types of information they used, in general and in different types of clinics. Design: Cross-sectional survey. Setting: Most physicians working in Sweden in 2017. Participants: A questionnaire was sent to 34 718 physicians; 54% responded. Analyses were based on answers from the 13 750 physicians who had sick leave cases. Outcome measures: To what extent the guidelines were used and what type of information from them that was used. Results: Ten years after the sickness certification guidelines were introduced in Sweden, half of the physicians used them at least once a month. About 40% of physicians in primary healthcare and occupational health services used the guidelines every week. The type of information used varied; 53% used recommendations about duration and 29% about degree of sick leave. Using information about function and activity/work capacity, respectively, was more common within primary healthcare (37% and 38%), psychiatry (42% and 42%), and occupational health services (35% and 41%), and less common in surgery and orthopaedic clinics (12% and 12%) who more often used information about duration (48% and 53%). Moreover, 10% stated that the guidelines were very, and 24% fairly problematic to apply. Half (47%) stated that the guidelines facilitated their contacts with patients and 29% that they improved quality in their management of sick leave cases. More non-specialists, compared with specialists, found that the guidelines facilitated contacts with patients (OR 3.28, 95% CI 3.04 to 3.55). Conclusions: The majority of the physicians used the sickness certification guidelines, although this varied with type of clinic. Half stated that the guidelines facilitated patient contacts. Yet, some found it problematic to apply the guidelines. Further development of the guidelines is warranted as well as more knowledge about them among physicians.
Dilemmas in sickness certification among Swedish physicians
The European Journal of Public Health, 1995
Despite a growing concern for matters related to sick-leave and its economical and human consequences, little Is still known of the practice of sickness certification. To remedy this, a study based on the crtticai inddent technique was designed to explore dilemmas experienced by physidans when issuing sickness certificates. A questionnaire was distributed to 170 general practitioners (GPs), private physidans and psychiatrists in the Swedish county of Ostergdtiand asking about sickness certification dilemmas, the consequences of the dilemma and how the situation was resolved. Through a semi-qualitative analysis, 2 main types of dilemma were identified. Insurance-associated dilemmas were the most frequent and concerned the grading of work incapacity, the duration of a sick-leave period and the difficulties in interpreting the sickness insurance legislation. The focus on biomedlcal diagnosis in the sickness certificate was found to complicate the certification routines, since working capacity may be reduced even though a diagnosis has not been confirmed. The primary medical dilemmas consisted of difficulties related to encountered obstacles in the clinical management, e.g. in subjective medical history, diagnosis or patient compliance. It is conduded that the physidans' role in the insurance system makes it necessary to give the medical diagnosis a social interpretation. The development of standards for grading of work incapacity is needed as well as routines for doser cooperation between the different actors in the sickness insurance system.
BMC Family Practice, 2012
Background: In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic. Methods: Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding. Results: Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave. Conclusions: The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.
Rates of sickness certification in European primary care: A systematic review
European Journal of General Practice, 2008
Background: General practitioners (GPs) are responsible for assessing a patient's capacity for work and issuing a sickness certificate, enabling a patient to receive statutory sick pay and take time away from the workplace. The management of sickness absence across Europe varies considerably, and there is a need for comparable rates of certification to facilitate appropriate health and economic planning. Objective: To systematically review the literature reporting rates of sickness certification in general practice settings. Methods: Electronic databases were searched from their inception to November 2007. Inclusion criteria were reporting a measure of sickness certification, conducted in European primary care. Results: 298 citations were identified from the literature search, of which 11 met the inclusion criteria. These studies demonstrated that the rates of sickness certification are not routinely recorded. The certified rates were subject to wide variation, ranging from 18 per 100 person years in Norway to 239 per 100 person years in Malta. Conclusion: There is large variability in sickness certification policy and hence sickness certification rates across Europe. A system that enables comparisons across countries would be beneficial in ensuring health and economic planning. To enable a baseline rate of certification to be established and compared across countries, standardized reporting of sickness certification is needed.