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Zanaboni P, Bergmo TS, Kristiansen E. Patients' experiences with receiving sick leave certificates via remote consultations in Norway during the COVID-19 pandemic: a nationwide online survey. BMJ Open 2024; 14:e075352. [PMID: 38272547 PMCID: PMC10824015 DOI: 10.1136/bmjopen-2023-075352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To explore patients' experiences with receiving sick leave certificates via remote consultations during the COVID-19 pandemic and investigate whether there were differences among the types of remote consultation (telephone, video or text). DESIGN A nationwide online patient survey consisting of quantitative data supplemented by qualitative opinions conducted in Norway. SETTING Primary care. PARTICIPANTS Patients who received a sick leave certificate via remote consultation in the period from 16 November to 15 December 2020. RESULTS Of the 5429 respondents, 3233 (59.6%) received a sick leave certificate via telephone consultation, 657 (12.1%) via video consultation and 1539 (28.3%) via text-based e-consultation. Most respondents (76.8%) were satisfied. Only 10% of the respondents thought that the doctor would have obtained more information through an office appointment. The majority of the respondents (59.6%) found that they had as much time to explain the problem as at an office appointment. Some patients also thought that it was easier to formulate the problem via a remote consultation (18.2%) and agree with the doctor on the sick leave (10.3%).The users of text-based e-consultations were the most satisfied (79.3%, p<0.001) compared with those using telephone or video consultations. Among users of text-based e-consultations, there was a higher proportion of patients who thought that they had more time to explain the problem compared with an office appointment (p<0.001), it was easier to explain the problem (p<0.001) and agree with the doctor (p<0.001). Most respondents would use the same type of remote consultation if they were to contact the general practitioner (GP) for the same problem, with the highest proportion among the users of video consultations (62.1%, p<0.001). CONCLUSIONS Patients were satisfied with communicating and receiving sick leave certificates via remote consultations. Future studies should investigate patients' and GPs' use and experiences in a postpandemic setting.
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Affiliation(s)
- Paolo Zanaboni
- University Hospital of North Norway, Tromso, Norway
- UiT The Arctic University of Norway, Tromso, Norway
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Drolet L, Caron PO, Forget J, Turcotte JR, Guimond C. Family physicians' sick-listing practices in relation to mental disorders: A descriptive study. Work 2022; 75:211-221. [PMID: 36591671 DOI: 10.3233/wor-211301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mental disorders are among the leading causes of disability for which family physicians are often required to complete sickness certificates. Yet, little is known about family physicians' sick-listing practices in Quebec. OBJECTIVE This study aims to describe their practices, difficulties and needs. METHODS Twenty-three family physicians completed a comprehensive questionnaire on sickness certification practices. Descriptive statistics were used. RESULTS Despite being completed on a weekly basis, sickness certifications were deemed problematic by all participants. While they rarely refused to sick-list a patient, 43.5% reported suggesting accommodations as an alternative to sick leave. Waiting-time to access psychotherapy and delays to set-up workplace accommodations are responsible for many unnecessary sick-leave prolongations. Lack of time, long duration absences, situations where the physician held a different opinion than the patient/healthcare provider and assessing an individual's capacity to work are the most common reported problems. More than half of participants indicated medical schools do not greatly prepare them to carry out these tasks. CONCLUSION Sickness certifications are deemed problematic, and more training might be key. Our results can be used by medical schools or bodies responsible for continuous education to improve training.
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Affiliation(s)
| | | | | | | | - Claude Guimond
- Fédération des Médecins Omnipraticiens du Québec, Quebec, QC, Canada
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3
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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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4
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Sturesson M, Bylund SH, Edlund C, Falkdal AH, Bernspång B. Collaboration in work ability assessment for sick-listed persons in primary healthcare. Work 2020; 65:409-420. [PMID: 32007984 DOI: 10.3233/wor-203093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work. OBJECTIVE Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave. METHODS Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention's implementation. RESULTS No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient. CONCLUSION Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.
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Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Sonya Hörnqvist Bylund
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
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5
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Nantha YS, Hs AS. Sickness Certification Behavior amongst Primary Care Physicians: A Descriptive Analysis of Indirect Measures Using the Theory of Planned Behavior. Korean J Fam Med 2020; 41:267-270. [PMID: 31992021 PMCID: PMC7385300 DOI: 10.4082/kjfm.18.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 11/08/2022] Open
Abstract
Background The provision of sick leave to patients in general practice often entails a complex decision-making process. Commonly, general practitioners believe that the act of providing sick leave can become confrontational. We assessed the intention, attitude, subjective norm, and perceived behavioral control of general practitioners in relation to sick leave provision at public health clinics in Malaysia. Methods A cross-sectional study design was implemented using data from 86 primary health care clinics in two states in Malaysia from February 2014 to March 2015. A questionnaire that comprised indirect measures were developed on the basis of the Theory of Planned Behavior. The questionnaire assessed several dimensions related to sickness certification provision viz., intention, attitude, subjective norm, and perceived behavioral control. Results The mean scores in this study revealed that physicians acknowledged that patient factors such as clinical symptoms (6.59±0.04), debilitating signs and symptoms of diseases (6.45±0.06), importance of illness recovery (6.07±0.07), and approval of employers (5.35±0.09) played an important role in their decision to provide sick leave. Conclusion The act of providing sickness certification to patients is a complex decision-making process. The findings of this study can be used to devise a targeted intervention to reduce the conflict that physicians face in issuing sick leaves.
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Affiliation(s)
- Yogarabindranath Swarna Nantha
- Primary Care Research Initiative and Methods Education Department (PRIMED), Seremban Primary Care Clinic, Seremban, Malaysia.,Monash University Malaysia, Subang Jaya, Malaysia
| | - Arvinder-Singh Hs
- Primary Care Research Initiative and Methods Education Department (PRIMED), Seremban Primary Care Clinic, Seremban, Malaysia.,Research Centre (Perak), Raja Permaisuri Bainun Hospital, Ipoh, Malaysia
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6
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Aarseth G, Natvig B, Engebretsen E, Lie AK. Acting by persuasion- values and rhetoric in medical certificates of work incapacity: A qualitative document analysis. MEDICAL HUMANITIES 2019; 45:60-66. [PMID: 30228222 DOI: 10.1136/medhum-2018-011496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
When the patient applies for disability benefit in Norway, the general practitioner (GP) is required by the National Insurance Administration (NAV) to confirm that the patient is unfit for work due to disease. Considering the important social role of medical certificates, they have been given surprisingly little attention by the medical critique. They may make essential differences to peoples' lives, legitimise large social costs and, in addition, the GPs report that issuing certificates can be problematic. This article explores values, attitudes and persuasive language in a selection of medical certificates written by GPs. We direct attention to such texts as significant social actors using a mixed rhetoric including certain values and attitudes. When arguing for granting the patient disability benefit, some GPs emphasised the 'worthiness' of the patient by pointing to positive attitudes approved by the national insurance: a will to work and participate, to cooperate and be motivated. Others pointed out the patient's positive character in terms of universally accepted values, called for the reader's (the NAV official) sympathy , understanding and helpfulness or appealed to his/her willingness to be realistic and pragmatic and grant disability benefit (DB). The dialogic style varied: some certifiers-although they argued for disability benefit-showed openness to possible opposing or alternative voices by displaying their own uncertainty. Others addressed the reader to share responsibility, demanding or urging for DB. This shifting rhetoric, we believe, mirrors that the GPs see themselves as the patient's advocate, and that they may find themselves conflicted. We propose further studies within qualitative research to investigate the effect of this rhetoric on the reader, the decision-makers. In addition, to improve the quality and accuracy of these important documents, we suggest that medical schools introduce students to the making of text as a specific skill of medical practice.
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Affiliation(s)
- Guri Aarseth
- Institute of Health and Society, Department of General Practice, University of Oslo, Oslo, Norway
| | - Bård Natvig
- Institute of Health and Society, Department of General Practice, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- Institute of Health and Society, Department of Health Sciences, University of Oslo, Oslo, Norway
| | - Anne Kveim Lie
- Institute of Health and Society, Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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7
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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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8
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Sylvain C, Durand MJ, Maillette P. Insurers' Influences on Attending Physicians of Workers Sick-listed for Common Mental Disorders: What Are the Impacts on Physicians' Practices? JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:531-540. [PMID: 29192369 DOI: 10.1007/s10926-017-9744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose In many jurisdictions, general practitioners (GPs) play an important role in the sick-leave and return-to-work (RTW) process of individuals with common mental disorders (CMD). Since it is insurers that decide on workers' eligibility for disability benefits, they can influence physicians' ability to act. The nature of these influences remains little documented to date. The aim of this study was therefore to describe these influences and their impacts from the GPs' perspective. Methods Semi-structured interviews were conducted with GPs having a diversified clientele (n = 13). The interviews were audio-recorded, transcribed verbatim and analyzed according to thematic analysis principles. Results The results indicated that the GPs recognized insurers as influencing their practices with patients on sick leave for CMDs. The documented influences were generally seen as constraints, but sometimes as enablers. The impacts of these influences on the GPs' practices depended on the organizational characteristics of their work context (such as limited consultation time) and other characteristics of their practice setting (such as lack of timely access to consultations with specialists). Conclusion The results brought three major issues to light: the quality of the information sent to insurers by GPs, the respect shown (or not) for workers' care preferences, and the relevance of the specialized services offered to support workers' RTW. These issues in turn reveal potential risks for workers, risks that need to be identified and recognized by all parties concerned if we are to come up with possible solutions.
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Affiliation(s)
- Chantal Sylvain
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada.
| | - Marie-José Durand
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada
| | - Pascale Maillette
- Centre for Action in Work Disability Prevention and Rehabilitation (CAPRIT), Hôpital Charles-Le Moyne Research Centre, Université de Sherbrooke, Longueuil Campus, 150 Place Charles LeMoyne, Longueuil, QC, J4K 0A8, Canada
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Bertilsson M, Maeland S, Löve J, Ahlborg G, Werner EL, Hensing G. The capacity to work puzzle: a qualitative study of physicians' assessments for patients with common mental disorders. BMC FAMILY PRACTICE 2018; 19:133. [PMID: 30060734 PMCID: PMC6066915 DOI: 10.1186/s12875-018-0815-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Entitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians' clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians' tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders. METHODS We performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool. RESULTS Five categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2-4 identified the particular essential pieces of information the participants used, relating to the patient's disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity. CONCLUSIONS Physicians' tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions' tacit knowledge, acceptance of the model can be expected to be high.
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Affiliation(s)
- Monica Bertilsson
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
| | - Silje Maeland
- Uni Research Health, Uni Research, Bergen, Norway
- Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health and Social sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jesper Löve
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
| | - Gunnar Ahlborg
- Institute of Medicine/Occupational and Environmental Health, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Erik L. Werner
- Uni Research Health, Uni Research, Bergen, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
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Hinkka K, Niemelä M, Autti-Rämö I, Palomäki H. Physicians’ experiences with sickness absence certification in Finland. Scand J Public Health 2018; 47:859-866. [DOI: 10.1177/1403494818758817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: The aim of this study was to explore Finnish physicians’ perceptions of sickness absence (SA) certification. Methods: A questionnaire was sent to 50% of the physicians in Finland who provide care to working-age patients in a clinical practice setting. Of the 8867 physicians, 3089 responded. Physicians handling SA certification patients at least a few times per month were included ( n = 2472). Results: At least a few times per month, 61% of all physicians perceived SA issues as problematic, 60% had experienced a lack of time in dealing with SA matters, 36% had disagreed with a patient on SA certification, and 36% had met a patient who wanted a SA certificate for reasons other than a disease or injury. Physicians were least worried about patients filing complaints (4%), exhibiting threatening behaviour (2%), or switching physicians for SA certification reasons (1%). A total of 60% of physicians had prescribed SA for a longer period than necessary because of long waiting times for further care/measures. Non-specialized physicians, general practitioners, and psychiatrists experienced problems more frequently than surgeons and occupational health physicians. Over 50% of the respondents had a fairly large or very large need to deepen their knowledge of social insurance matters. The need for national guidelines for all or some diseases was reported by 80% of the respondents. Conclusions: Many physicians perceive SA tasks as problematic and are unable to dedicate enough time to them. Shortcomings in physicians’ sickness certification know-how, as well as obstacles in the healthcare and rehabilitation system, prolong the SA process. Attitudes towards the adoption of national guidelines on the duration of SA were positive.
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Affiliation(s)
- Katariina Hinkka
- Research Department, Social Insurance Institution of Finland, Turku, Finland
| | - Mikko Niemelä
- Research Department, Social Insurance Institution of Finland, Turku, Finland
- Department of Social Sciences, University of Turku, Turku, Finland
| | - Ilona Autti-Rämö
- Insurance Medicine Unit, Social Insurance Institution of Finland, Helsinki, Finland
| | - Heikki Palomäki
- Insurance Medicine Unit, Social Insurance Institution of Finland, Helsinki, Finland
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11
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Swarna Nantha Y, Wee LH, Chan CMH. Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour. BMC FAMILY PRACTICE 2018; 19:18. [PMID: 29338699 PMCID: PMC5771020 DOI: 10.1186/s12875-017-0690-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
Background Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians. Methods A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions. Results The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p < 0.05). Attitudes and subjective norms were identified as important predictors in physician intention to provide sick leave to patients. Conclusion An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help regulate the provision of sickness leave and alleviate the work burden of sickness leave tasks faced by physicians in Malaysia. Electronic supplementary material The online version of this article (10.1186/s12875-017-0690-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Lei Hum Wee
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50586, Kuala Lumpur, Malaysia
| | - Caryn Mei-Hsien Chan
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50586, Kuala Lumpur, Malaysia
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12
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Aarseth G, Natvig B, Engebretsen E, Lie AK. 'Working is out of the question': a qualitative text analysis of medical certificates of disability. BMC FAMILY PRACTICE 2017; 18:55. [PMID: 28427338 PMCID: PMC5399412 DOI: 10.1186/s12875-017-0627-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/31/2017] [Indexed: 12/22/2022]
Abstract
Background Medical certificates influence the distribution of economic benefits in welfare states; however, the qualitative aspects of these texts remain largely unexplored. The present study is the first systematic investigation done of these texts. Our aim was to investigate how GPs select and mediate information about their patients’ health and how they support their conclusions about illness, functioning and fitness for work in medical certificates. Methods We performed a textual analysis of thirty-three medical certificates produced by general practitioners (GP) in Norway at the request of the Norwegian Labour and Welfare Administration (NAV).The certificates were subjected to critical reading using the combined analytic methods of narratology and linguistics. Results Some of the medical information was unclear, ambiguous, and possibly misleading. Evaluations of functioning related to illness were scarce or absent, regardless of diagnosis, and, hence, the basis of working incapacity was unclear. Voices in the text frequently conflated, obscuring the source of speaker. In some documents, the expert’s subtle use of language implied doubts about the claimant’s credibility, but explicit advocacy also occurred. GPs show little insight into their patients’ working lives, but rather than express uncertainty and incompetence, they may resort to making too absolute and too general statements about patients’ working capacity, and fail to report thorough assessments. Conclusions A number of the texts in our material may not function as sufficient or reliable sources for making decisions regarding social benefits. Certificates as these may be deficient for several reasons, and textual incompetence may be one of them. Physicians in Norway receive no systematic training in professional writing. High-quality medical certificates, we believe, might be economical in the long term: it might increase the efficiency with which NAV processes cases and save costs by eliminating the need for unnecessary and expensive specialist reports. Moreover, correct and coherent medical certificates can strengthen legal protection for claimants. Eventually, reducing advocacy in these documents may contribute to a fairer evaluation of whether claimants are eligible for disability benefits or not. Therefore, we believe that professional writing skills should be validated as an important part of medical practice and should be integrated in medical schools and in further education as a discipline in its own right, preferably involving humanities professors.
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Affiliation(s)
- Guri Aarseth
- Department of General Practice, University of Oslo, Faculty of Medicine, Institute of Health and Society, Postboks 1130, Blindern, 0318, OSLO, Norway.
| | - Bård Natvig
- Department of General Practice, University of Oslo, Faculty of Medicine, Institute of Health and Society, Postboks 1130, Blindern, 0318, OSLO, Norway
| | - Eivind Engebretsen
- Department of Health Science, University of Oslo, Faculty of Medicine, Institute of Health and Society, Postboks 1089, Blindern, 0318, OSLO, Norway
| | - Anne Kveim Lie
- Departement of Community Medicine and Global Health, University of Oslo, Faculty of Medicine; Institute of Health and Society, Postboks 1130, Blindern, 0318, OSLO, Norway
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Lännerström L, von Celsing AS, Holmström IK, Wallman T. Registered nurses' work with sick leave questions by telephone in primary health care. J Clin Nurs 2016; 26:641-647. [PMID: 27626185 DOI: 10.1111/jocn.13580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe registered nurses' work with sick leave questions by telephone. BACKGROUND In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies. DESIGN A descriptive cross-sectional study. METHODS A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis. RESULTS Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education. CONCLUSION Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine. RELEVANCE TO CLINICAL PRACTICE There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.
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Affiliation(s)
- Linda Lännerström
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna-Sophia von Celsing
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Health Services Research Section, Uppsala University, Uppsala, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Westlin E, Björklund A. A Delphi study of occurring information in housing adaptation certificates. Scand J Occup Ther 2016; 23:357-65. [DOI: 10.1080/11038128.2016.1177591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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de Boer WEL, Mousavi SM, Delclos GL, Benavides FG, Lorente M, Kunz R. Expectation of sickness absence duration: a review on statements and methods used in guidelines in Europe and North America. Eur J Public Health 2016; 26:306-11. [PMID: 26705569 PMCID: PMC4804735 DOI: 10.1093/eurpub/ckv222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Certifying physicians play a key role in the management of sickness absence and are often provided with guidelines. Some of these guidelines contain statements on expected sickness absence duration, according to diagnosis. We were interested in exploring the evidence base of these statements. METHODS We identified guidelines through a survey of EUMASS members and a literature search of the Internet and PubMed. We extracted the statements and methods from the guidelines. We compared: diagnoses that were addressed, expected durations and development processes followed. Next, we presented our findings to the developers, to afford them an opportunity to comment and/or correct any misinterpretations. RESULTS We identified 4 guidelines from social insurance institutions (France, Serbia, Spain and Sweden) and 4 guidelines from private organisations (1 Netherlands, 3 US). Guidelines addressed between 63 and some 63000 health conditions (ICD 10 codes). Health conditions overlapped among guidelines. Direct comparison is hampered by differences in coding (ICD 9 or 10) and level of aggregation (three or four digit, clustering of diseases and treatment situations). Expectations about duration are defined as minimum, maximum, and optimum or mean or median and percentile distribution, stratified to age and work requirements. In a sample of 5 diagnoses we found overlap in expected duration but also differences. Guidelines are developed differently, pragmatic expert consensus being used most, supplemented with data on sickness absence from different registers, other guidelines and non-systematic literature reviews. The effectiveness of these guidelines has not yet been formally evaluated. CONCLUSIONS Expectations about duration of sickness absence by diagnosis are expressed in several guidelines. The expectations are difficult to compare, their evidence base is unclear and their effectiveness needs to be established.
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Affiliation(s)
- Wout E L de Boer
- 1 Swiss Academy of Insurance Medicine, University Hospital Basel, Basel, Switzerland
| | - S Mohsen Mousavi
- 1 Swiss Academy of Insurance Medicine, University Hospital Basel, Basel, Switzerland
| | - George L Delclos
- 2 The University of Texas School of Public Health, Houston, TX, USA 3 Centre for Research in Occupational Health, Pompeu Fabra University, Barcelona, Spain
| | - Fernando G Benavides
- 3 Centre for Research in Occupational Health, Pompeu Fabra University, Barcelona, Spain
| | - Mercedes Lorente
- 4 Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés (CNAMTS), Paris, France
| | - Regina Kunz
- 1 Swiss Academy of Insurance Medicine, University Hospital Basel, Basel, Switzerland
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Mazza D, Brijnath B, Singh N, Kosny A, Ruseckaite R, Collie A. General practitioners and sickness certification for injury in Australia. BMC FAMILY PRACTICE 2015; 16:100. [PMID: 26275607 PMCID: PMC4537596 DOI: 10.1186/s12875-015-0307-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/10/2015] [Indexed: 12/02/2022]
Abstract
Background Strong evidence supports an early return to work after injury as a way to improve recovery. In Australia, General Practitioners (GPs) see about 96 % of injured workers, making them the main gatekeepers to workers’ entitlements. Most people with compensable injuries in Australia are certified as “unfit to work” by their GP, with a minority of patients certified for modified work duties. The reasons for this apparent dissonance between evidence and practice remain unexplored. Little is known about the factors that influence GP sickness certification behaviour in Australia. The aim of this study is to describe the factors influencing Australian GPs certification practice through qualitative interviews with four key stakeholders. Methods From September to December 2012, 93 semi-structured interviews were undertaken in Melbourne, Australia. Participants included GPs, injured workers, employers and compensation agents. Data were thematically analysed. Results Five themes describing factors influencing GP certification were identified: 1. Divergent stakeholder views about the GP’s role in facilitating return to work; 2. Communication between the four stakeholder groups; 3. Conflict between the stakeholder groups; 4. Allegations of GPs and injured workers misusing the compensation system and 5. The layout and content of the sickness certificate itself. Conclusion By exploring GP certification practice from the perspectives of four key stakeholders, this study suggests that certification is an administrative and clinical task underpinned by a host of social and systemic factors. The findings highlight opportunities such as practice guideline development and improvements to the sickness certificate itself that may be targeted to improve GP sickness certification behaviour and return to work outcomes in an Australian context. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0307-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Nabita Singh
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Melbourne, Australia.
| | - Agnieszka Kosny
- Institute for Work and Health, University of Toronto, Toronto, Canada.
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia. .,Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia.
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Sturesson M, Bylund SH, Edlund C, Falkdal AH, Bernspång B. Quality in sickness certificates in a Swedish social security system perspective. Scand J Public Health 2015; 43:841-7. [PMID: 26229074 DOI: 10.1177/1403494815597163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/17/2022]
Abstract
AIM In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate. METHODS An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. RESULTS Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found. CONCLUSION Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters.
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Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
| | | | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University Sweden
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Carlsson L, Lännerström L, Wallman T, Holmström IK. General practitioners' perceptions of working with the certification of sickness absences following changes in the Swedish social security system: a qualitative focus-group study. BMC FAMILY PRACTICE 2015; 16:21. [PMID: 25888369 PMCID: PMC4339246 DOI: 10.1186/s12875-015-0238-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 02/03/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many physicians in Sweden, as well as in other countries, find the matter of certification of sickness absence (COSA) particularly burdensome. The issuing of COSAs has also been perceived as a work-environment problem among physicians. Among general practitioners (GPs) are the highest proportion of physicians in Sweden who experience difficulties with COSA. Swedish authorities have created several initiatives, by changing the social security system, to improve the rehabilitation of people who are ill and decrease the number of days of sick leave used. The aim of this study was to describe how GPs in Sweden perceive their work with COSA after these changes. METHODS A descriptive design with a qualitative, inductive focus-group discussion (FGD) approach was used. RESULTS Four categories emerged from the analysis of FGDs with GPs in Sweden: 1) Physicians' difficulties in their professional role; 2) Collaboration with other professionals facilitates the COSA; 3) Physicians' approach in relation to the patient; 4) An easier COSA process. CONCLUSIONS Swedish GPs still perceived COSA to be a burdensome task. However, system changes in recent years have facilitated work related to COSA. Cooperation with other professionals on COSA was perceived positively.
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Affiliation(s)
- Lars Carlsson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Box 564, 75122, Uppsala, Sweden.
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
| | - Linda Lännerström
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Box 564, 75122, Uppsala, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Box 564, 75122, Uppsala, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
- Department of Public Health and Caring Sciences, Health Services Research Section, Uppsala University, Uppsala, Sweden.
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Healthcare encounters and return to work: a qualitative study on sick-listed patients’ experiences. Prim Health Care Res Dev 2014; 15:464-75. [DOI: 10.1017/s1463423614000255] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Rudbeck M. Variation in patients’ sick leave between general practitioner practices. Scand J Public Health 2014; 42:621-6. [DOI: 10.1177/1403494814541019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: General practitioners (GPs) assess the existence of the patient’s disease, decide whether the disease affects the patient’s ability to work and if necessary, recommend sick leave. Our aim was to describe correlations in patients’ sick leave between GP practices (GPPs) in a 5-year period. Method: The study included 253 GPPs, from 2007 to 2011. The personal numbers of patients from each GPP were connected to DREAM, a registry at the Danish Ministry of Employment that includes social welfare payments, including sick leave benefits. We adjusted for patient age, gender, ethnicity and social differences. Spearman’s rank correlation coefficients (2007 – 2011) were used for calculating the correlation in adjusted sick leave. Results: The number of patient sick leave weeks between GPPs varied from 36 to 2,704 sick leave weeks per 1000 patients (18 – 65 years). The correlation coefficients for adjusted sick leave weeks varied from 0.90 to 0.94 ( P < 0.05). Correlations for the 10 GPPs with the highest number of sick leave weeks and the 10 GPPs with the lowest number of sick leave weeks were almost as high as the correlations of the total population of GPPs. Conclusions:The study showed great differences in sick leave between GPPs; however, significant correlation for adjusted sick leave in each GPP was demonstrated. This may indicate that GPs play an important role in their patients’ sick leave. The study provides a method to distinguish between GPPs with low patient sick leave and high patient sick leave in causal studies of sick leave differences among GPs.
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Affiliation(s)
- Marianne Rudbeck
- Department of Social Medicine, Aalborg University Hospital, Denmark
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21
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Ericson Sjöström M, Wallin I, Strandhagen E, Baigi A, Hensing G, Björkelund C. GP and patient predictions of sick-listing duration: how well do they correspond? A prospective observational study. Scand J Prim Health Care 2014; 32:73-7. [PMID: 24939740 PMCID: PMC4075020 DOI: 10.3109/02813432.2014.915132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore how well physicians and patients predict sick-listing duration and the correspondence between their respective predictions. To study possible gender differences concerning prediction accuracy. DESIGN Prospective observational study. SETTING Two medium-sized primary care centres (PCC) in western Sweden. SUBJECTS GPs at the PCCs and attending patients sick-listed for > 14 days. MAIN OUTCOME MEASURES Sick-listing duration; patients' and GPs' predictions of the total duration of the individual patient's sick-listing. RESULTS A total of 127 patients (93 women, 34 men, mean age 45 years) and 10 GPs participated in the study. Neither the GPs nor the patients were able to predict the interval until return to work with high accuracy. The GPs' and the patients' perceptions concurred in only 26% of cases. There was a significant difference in the correspondence between the GPs' and patients' respective predictions of sick-listing duration compared with the actual duration. GPs' predictions were more accurate for medium-length duration (1.5-6 months), while patients' predictions were more accurate for long-duration (> 6 months) sick-listing. Patients with less education predicted long duration of sick-listing more accurately than those with more education. There was no significant difference between male and female patients' accuracy of prediction, or between GPs' accuracy of prediction of male vs. female patients' sick-listing duration. CONCLUSIONS Prediction of total sick-listing duration was hard for both GP and patient; their respective predictions corresponded in only one-quarter of the cases. No gender differences were observed in the accuracy of prediction.
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Affiliation(s)
- Monica Ericson Sjöström
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sweden
| | - Inger Wallin
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Elisabeth Strandhagen
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Amir Baigi
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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Brekke D. Retningslinjer påvirker ikke sykmeldingsomfanget. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:2131-2. [DOI: 10.4045/tidsskr.14.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Warren PA. Those Who Hesitate are Lost: The Case for Setting Behavioral Health Treatment and Disability Standards, Part II. PSYCHOLOGICAL INJURY & LAW 2013. [DOI: 10.1007/s12207-013-9164-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Foley M, Thorley K, Von Hout MC. Sickness certification difficulties in Ireland--a GP focus group study. Occup Med (Lond) 2013; 63:369-72. [PMID: 23719322 DOI: 10.1093/occmed/kqt056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties. AIMS To explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland. METHODS A qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used. RESULTS Three major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification. CONCLUSIONS GPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.
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Affiliation(s)
- M Foley
- Centre for Occupational and Environmental Health Research, University of Manchester, Manchester M13 9PL, UK.
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Gustavsson C, Kjeldgård L, Bränström R, Lindholm C, Ljungquist T, Nilsson GH, Alexanderson K. Problems experienced by gynecologists/obstetricians in sickness certification consultations. Acta Obstet Gynecol Scand 2013; 92:1007-16. [PMID: 23663218 DOI: 10.1111/aogs.12169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/05/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore frequencies and experiences with problems in sickness certification consultations among gynecologists and obstetricians in two different years. DESIGN Cross-sectional surveys on two occasions; in 2004 and 2008. SETTING Gynecological, obstetric and maternal health care. SAMPLE Physicians working in gynecology, obstetrics or maternal health care in two Swedish counties from two samples: in 2004 (n = 315), and in 2008 (n = 327). METHODS Data regarding sickness certification consultations were obtained from comprehensive questionnaires that had been mailed to the physicians in two Swedish counties in 2004 and in 2008, respectively. OUTCOME MEASURES Frequencies and types of problems in sickness certification consultations, organizational support, and need to acquire more competence. RESULTS The majority experienced that patients requested to be on sick leave for a reason other than work incapacity due to disease or injury, at least a few times per year (85% in 2004 and 88% in 2008). The most problematic situation to handle was when the physician and the patient had different opinions about the need for sick leave (2004: 66% and 2008: 58%). The physicians expressed a need for more competence about the options and responsibilities of employers, social insurance officers and physicians in sickness certification cases. CONCLUSIONS Most gynecologists/obstetricians find sickness certification consultations problematic and especially when encountering patients requesting to be on sick leave for reasons other than disease. The physicians expressed a need for more competence in insurance medicine, especially about their own and other stakeholders' options and responsibilities.
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Affiliation(s)
- Catharina Gustavsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Letrilliart L, Barrau A. Difficulties with the sickness certification process in general practice and possible solutions: A systematic review. Eur J Gen Pract 2012. [DOI: 10.3109/13814788.2012.727795] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Helena Liira
- Department of General Practice and Primary Care, University of Helsinki, E-mail:
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Beach J, Benoit M, Rowe BH, Cherry N. Can emergency physicians predict severity and time away from work? Occup Med (Lond) 2012; 62:648-50. [PMID: 23012345 DOI: 10.1093/occmed/kqs174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emergency and primary care physicians are often asked to estimate patients' likely duration of sickness absence or temporary disability following work-related injury or illness. However, return to work is a complex interaction of multiple factors and often difficult to predict accurately. AIMS To compare physician estimates of expected time away from work and severity of injury, made at the time of the initial presentation, with actual duration of temporary disability following work-related shoulder or knee injury. METHODS Patients aged 18-65 with work-related shoulder or knee injuries who attended one of three Edmonton Emergency Departments were recruited. For each participant the treating physician made an estimate of severity and expected time before they would return to their work. This was compared with information on actual temporary disability (TDdays) obtained from the Alberta Workers' Compensation Board (WCB) data. RESULTS Over the study period, 443 (88%) of 501 patients were enrolled into the study; however, only 177 (35%) agreed to linking their data with WCB. Median TDdays increased with the physicians' estimates of both severity and likely temporary disability. Physicians tended to underestimate time off work for those with long duration of TDdays, but overestimated this for those with short durations. CONCLUSIONS Emergency physicians' estimates of expected lost work time and severity of injury were correlated with actual temporary disability, although their accuracy was fairly low. Further work to define why differences between estimated and actual temporary disability occur could help physicians and others planning return to work.
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Affiliation(s)
- Jeremy Beach
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Aamland A, Malterud K, Werner EL. Phenomena associated with sick leave among primary care patients with Medically Unexplained Physical Symptoms: a systematic review. Scand J Prim Health Care 2012; 30:147-55. [PMID: 22817103 PMCID: PMC3443938 DOI: 10.3109/02813432.2012.704812] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To explore and synthesize the literature on phenomena associated with sick leave among patients with Medically Unexplained Physical Symptoms (MUPS). DESIGN A systematic review of the literature was undertaken in three phases: (1) a search of the following databases: Medline, Embase, Psych Info, Cochrane Collaboration Library, Digital Dissertations, DiVA, SweMed +, NORART, and ISI Web of Science, (2) selection of studies based on pre-specified inclusion criteria was undertaken, extracting study design and results, (3) quality assessment was undertaken independently by two reviewers. Due to heterogeneity in study designs, populations, interventions, and outcome measures, a mixed research synthesis approach was used. Results were assessed in a pragmatic and descriptive way; textual and numerical data were extracted from the included studies, and classified into patient- and doctor-related factors. RESULTS Sixteen studies were included. With regard to patients, an association was found between sick leave and psychiatric comorbidity as well as total symptom burden. With regard to doctors, knowledge of the patient, sympathy, and trust appeared to increase the probability of the patient being sick-listed. None of the interventions in the educational programmes aiming to improve doctors' management of MUPS patients succeeded in lowering sick leave. IMPLICATIONS Despite MUPS being a leading cause of sickness absence, the review identified only a small number of studies concerning phenomena associated with sick leave. The authors did not identify any studies regarding the impact of the working conditions on sick leave among MUPS patients. This is an important area for further studies.
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Affiliation(s)
- Aase Aamland
- Research Unit for General Practice in Bergen, Uni Health, Uni Research, Bergen, Norway.
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