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Hällås E, Skoglund I, Nordeman L. "That's probably how you would want care to be" - experiences of sick leave teams at a health center, a mixed method study. BMC PRIMARY CARE 2023; 24:243. [PMID: 37978438 PMCID: PMC10655286 DOI: 10.1186/s12875-023-02192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The health center where this study was performed the management wanted to test whether a sick leave team provided the physicians with better conditions for the task of assessing sick leave. The goals were to ensure the quality of the assessment of patients with sick leave needs and to improve the work environment. The aim of this study was to take part in the staff's experiences of having access to and working in sick leave teams and how the working method affected the number of sick leave patients and sick leave pattern. METHODS A mixture of qualitative and quantitative methods. Two focus groups were conducted with a total of 11 participants. The head of the health center formed the focus groups, which consisted of 6 doctors, 3 district nurses, 1 rehab coordinator and 1 psychologist. Aggregated sick leave data for full-time and part-time sick leave of more than 90, 180 and 360 days, respectively, were obtained and compiled at project start and end, and from the corresponding period 18 months before project start. RESULTS The introduction of sick leave teams with physicians and rehabilitation coordinator for patients who turn to the health center for mental illness and / or musculoskeletal problems emerged three main categories from the analysis of the focus group discussions: working environment, clear roles and in-depth competence. The total number of people who were on sick leave more than 365 days decreased by 27% between start and the end of the project, and the proportion of women increased by 11%. CONCLUSIONS The study shows that the complex task of sick leave can be perceived as positive by physicians with the support of teamwork. The working method is similar to that applied in occupational health care, where the physician is not alone with this task. This can also be a way to make primary care a more attractive workplace.
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Affiliation(s)
- E Hällås
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden.
| | - I Skoglund
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Nordeman
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Working Conditions of Occupational Physicians-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106222. [PMID: 35627762 PMCID: PMC9141582 DOI: 10.3390/ijerph19106222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 01/03/2023]
Abstract
Occupational physicians (OPs) offer a wide range of health support for employees and are confronted with varying job characteristics and demands. They monitor occupational health and safety and promote work(place)-related health measures and assessments. While helping employees to (re)gain a healthy status, their own job satisfaction as well as the investigation of their working conditions have earned limited research attention. Thus, this scoping review aims to summarize the current state of knowledge concerning OPs’ working conditions, i.e., work-related resources and stressors. PubMed, Web of Science and LIVIVO as well as grey literature were screened for relevant English or German articles until 10/2021. From a total of 1683 identified publications, we analyzed 24 full text articles that fulfilled all inclusion criteria. The overall study sample included 3486 male (54.6%), 2892 female (45.3%) and 5 diverse OPs, from which 1049 OPs worked in full-time (85.6%) and 177 in part-time (14.4%). The majority (72.4%) worked for the Occupational Health Service (OHS), 13% were self-employed, and 14.6% worked for a company/in-house service. The classification of stressors and resources was based on an inductively generated categorization scheme. We categorized 8 personal, relational and environmental resources and 10 stress factors. The main resources were support for personnel development and promotion, positive organizational policy, promoting work-life balance and other aspects of health. Key stressors were information deficits, organizational deficiency and uncertainty as well as socioeconomic influences and high professional obligations. The working conditions of OPs are still a topic with too little research attention. This scoping review reveals several starting points to maintain a healthy OP workforce and gives recommendations for action for the near future.
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Horppu R, Väänänen A, Kausto J. Evaluation of a guidelines implementation intervention to reduce work disability and sick leaves related to chronic musculoskeletal pain: a theory-informed qualitative study in occupational health care. BMC Musculoskelet Disord 2022; 23:272. [PMID: 35317760 PMCID: PMC8938719 DOI: 10.1186/s12891-022-05234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines for pain management and sick leave prescription were formulated and implemented in an occupational health services (OHS) in Finland to reduce work disability and sick leaves related to musculoskeletal pain. We investigated how the guidelines implementation intervention may have produced its effects, how the number of prescribed sick leave days varied before and after the launch of the guidelines, and which factors beyond physician behaviour were seen to influence sick leaves. Methods Seventeen physicians, two occupational physiotherapists and one occupational health care nurse were interviewed. Qualitative content analysis using both inductive and deductive approaches was performed, informed by Behaviour Change Wheel and Theoretical Domains Framework. Employees’ sick leave days related to musculoskeletal disorders in 2015–2019 were drawn from the employer’s register. Results Physicians’ guidelines adherence was facilitated by psychological capability (e.g., having relevant knowledge, remembering to engage in recommended behaviours), reflective motivation (e.g., guidelines-related behaviours regarded as central part of one’s professional role; beliefs in the positive consequences of recommended behaviours to employees and employers), and physical and social opportunities (e.g., adequate physical resources, culture of social support). Some physicians also described barriers to recommended behaviours (e.g., lack of knowledge or non-pharmacological pain treatment tools). The guidelines had served as sources of new knowledge, reminders of recommended practices and means of self-assessment. Considerable declining trend of prescribed sick leave days was detected, especially during the first years after the intervention, levelling off somewhat thereafter. OHS policies and structures were seen to enable professionals’ focusing on preventing pain-related disability and prolonged sick leaves. The decline of sickness absences was also attributed to the municipal client organization’s commitment and the employees’ positive attitudes towards the alternatives to full-time sick leave. Conclusions The guidelines implementation intervention was found successful. The study showed the importance of social and organizational environment supporting physicians’ engagement in recommended practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05234-8.
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Affiliation(s)
- Ritva Horppu
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland.
| | - Ari Väänänen
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland
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Svärd V, Alexanderson K. Physician's use of sickness certification guidelines: a nationwide survey of 13 750 physicians in different types of clinics in Sweden. BMJ Open 2021; 11:e051555. [PMID: 34907056 PMCID: PMC8672016 DOI: 10.1136/bmjopen-2021-051555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Social Work, Södertörn University, Huddinge, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hultén AM, Dahlin-Ivanoff S, Holmgren K. Positioning work related stress - GPs' reasoning about using the WSQ combined with feedback at consultation. BMC FAMILY PRACTICE 2020; 21:187. [PMID: 32917138 PMCID: PMC7488670 DOI: 10.1186/s12875-020-01258-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/31/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave. METHODS A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger. RESULTS Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress. CONCLUSIONS The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated. TRIAL REGISTRATION ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.
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Affiliation(s)
- Anna-Maria Hultén
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Synneve Dahlin-Ivanoff
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bengtsson Boström K, Starzmann K, Östberg AL. Primary care physicians' concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden. Scand J Prim Health Care 2020; 38:146-155. [PMID: 32314635 PMCID: PMC8570729 DOI: 10.1080/02813432.2020.1753341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification.Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis.Setting: Urban and rural PHC centres in Region Västra Götaland, Sweden.Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed.Main outcome measures: Experiences and reflections about the sickness certification system.Results: The latent content was formulated in a theme: 'The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients'. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians' coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers.Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians' work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care. KEY POINTSIn 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians' work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients.Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances.A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.
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Affiliation(s)
- Kristina Bengtsson Boström
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University og Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
| | - Karin Starzmann
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University og Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
| | - Anna-Lena Östberg
- Regionhälsan R&D Centre Skaraborg Primary Care, Skövde, Sweden
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Atkins S, Reho T, Talola N, Sumanen M, Viljamaa M, Uitti J. Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data. Trials 2020; 21:256. [PMID: 32164777 PMCID: PMC7068938 DOI: 10.1186/s13063-020-4168-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prolonging working careers is a key policy goal in ageing populations in Europe, but reaching this goal is complex. Occupational health services are in the best position to contribute towards prolonging working careers through preventing illnesses that cause work disability and early retirement. However, impacting on the trajectory between illness and work disability requires continuity of care and follow up, enabled through identifying patients at risk. We aimed to determine whether a combined educational and electronic reminder system in occupational health care could improve the recording and follow up of primary care visits made by patients at risk of work disability, and whether the system could impact on sickness absence rates. METHODS This study is a pragmatic, cluster-randomized controlled trial using medical record data. Twenty-two Pihlajalinna Työterveys units were randomized into an intervention group receiving education and electronic reminders or a group receiving usual care through minimization methods. Patient consultation data were extracted from routine Pihlajalinna Työterveys patient registers from 2015 to 2017. In addition, process indicators were collected from the electronic system. Data were cleaned and analysed on an intention-to-treat basis using analysis of covariance. RESULTS There was no significant difference between intervention and control units in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians' practice of recording patients' risk of work disability and work-relatedness of visits following the educational intervention. CONCLUSION Education with an electronic reminder can change physicians' practice, but long-term follow up is needed to determine whether this impacts on patients' sickness absences. TRIAL REGISTRATION ISRCTN Registry: ISRCTN45728263. Registered on 12 April 2016.
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Affiliation(s)
- Salla Atkins
- New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland. .,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Tiia Reho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Pihlajalinna Työterveys, Tampere, Finland
| | - Nina Talola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Church of Finland, Tampere, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland.,Occupational medicine clinic, Tampere University Hospital, Tampere, Finland
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Weerdesteijn KHN, Schaafsma FG, van der Beek AJ, Merkus SL, Maeland S, Hoedeman R, Lissenberg-Witte BI, Werner EL, Anema JR. Sick leave assessments of workers with subjective health complaints: a cross-sectional study on differences among physicians working in occupational health care. Disabil Rehabil 2019; 42:967-974. [PMID: 30688122 DOI: 10.1080/09638288.2018.1513085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: To obtain more insight into differences in sick leave assessments of workers with subjective health complaints, we studied sick leave assessments among Dutch occupational and insurance physicians, and explored possible determinants for these differences.Methods: A cross-sectional study was conducted among 50 occupational and 43 insurance physicians in the Netherlands. They all assessed sick leave (complete, partial or no) of nine video case vignettes of workers with subjective health complaints and gave their opinion on the complaints, sick leave and health status. Data were analyzed via a multinomial regression approach, using generalized estimating equations in SPSS.Results: Compared to occupational physicians, complete sick leave was less likely to be assessed by insurance physicians (odds ratio 0.74, 95% confidence interval 0.56-0.97). For occupational physicians, psychological diagnoses, private issues and reduced work ability had more influence on the outcome of the sick leave assessment than for insurance physicians.Conclusion: There are differences in sick leave assessments for workers with subjective health complaints between physicians working in the same occupational health system; insurance physicians are stricter in assessing complete sick leave than occupational physicians. These differences may be explained by differences in roles, tasks and perspectives of the physician in occupational health care.Implications for Rehabilitation Sick leave assessments of workers with subjective health complaints. • The current study showed that there are differences between occupational physicians and insurance physicians in sick leave assessments for workers with subjective health complaints. • These differences may be based on different perspectives, roles and tasks of physicians. • Physicians working in the rehabilitation and occupational health system should be more aware of the impact of these differences on their assessments and advices. • Better communication and collaboration between physicians, and more insight into and clarification of the perspectives may result in more agreement between physicians' sick leave assessment and advice towards workers.
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Affiliation(s)
- Kristel H N Weerdesteijn
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.,Department of Social Medical Affairs, The Dutch Social Security Institute: the Institute for Employee Benefits Schemes, Amsterdam, the Netherlands
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Suzanne L Merkus
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Uni Research Health, Uni Research, Bergen, Norway
| | - Silje Maeland
- Department of Uni Research Health, Uni Research, Bergen, Norway
| | - Rob Hoedeman
- Department of Science, ArboNed Occupational Health Services, Utrecht, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik L Werner
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Johannes R Anema
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Problems with sickness certification tasks: experiences from physicians in different clinical settings. A cross-sectional nationwide study in Sweden. BMC Health Serv Res 2015; 15:321. [PMID: 26264627 PMCID: PMC4533961 DOI: 10.1186/s12913-015-0937-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many physicians find sickness certification of patients problematic. The aims were to explore problems that physicians in different clinical settings experience with sickness certification tasks in general and with assessment of function, work capacity, and need for sick leave, as well as handling of sick-leave spells of different durations. METHODS Data from a questionnaire sent to 33,144 physicians aged <68 years, living and working in Sweden in 2012 were analysed. The response rate was 57.6%. The study group comprised the 12,933 responders who had sickness certification tasks. Frequencies and odds ratios with 95% confidence intervals were calculated for questions concerning how problematic the physicians experienced different assessments related to patients' function, work capacity, and need for sick leave, as well as handling sick-leave spells of different durations. RESULTS There were large differences between clinical settings regarding how often and to what extent sickness certification consultations were perceived as problematic. Physicians working in primary health care (PHC) had the highest proportions experiencing sickness certification consultations as problematic at least once a week (49.5%) and as very or fairly problematic (56.6%), followed by physicians working in psychiatry, pain management, or orthopaedics. More than half of the responders found it very or fairly problematic to assess patients' work capacity (57.8%), to make a long-term prognosis about patients' future work capacity (55.7%), and to handle long-term or very long-term sickness certifications (51.9% and 51.8%). The proportions were highest among physicians working in PHC, rheumatology, neurology, or psychiatry. CONCLUSIONS The rates of physicians finding sickness certification task problematic varied much with clinical setting, and were highest among physicians in PHC. More knowledge is needed about the work conditions and prerequisites for optimal handling of sickness certification in different clinical settings.
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