Reporting and prediction of work-related sickness absence by general practitioners

BACKGROUND

Information on sickness absence (SA) duration in general practice is difficult to record. The duration of absence certified by general practitioners (GPs) can be viewed as a prognosis for return to work. The Health and Occupation Research network in General Practice (THOR-GP) collects SA information from GPs associated with cases of work-related ill-health. A sample of these cases is followed up 1 year retrospectively to gather information on the duration of absence.

AIMS

To examine the extent of the underestimation of SA in routinely reported data and to investigate how well GPs predict patients' return to work.

METHODS

THOR-GPs submit case and SA information using a web-based form. GPs who submitted selected cases were asked about the total number of days of SA and whether the patient had returned to work.

RESULTS

THOR-GPs' routine SA data collection underestimated absence duration by 61%. According to the retrospective data, a much larger proportion of periods of absence due to work-related mental ill-health developed into long-term SA (60%) than episodes attributed to musculoskeletal disorders (32%). In over half the reported cases, the return to work was longer than the GP initially predicted.

CONCLUSIONS

THOR-GP prospectively reported SA data underestimated the total length of absence; however, these data can examine the episodic rates of absence within different groups. More accurate longitudinal data can be collected retrospectively. GPs' ability to predict the length of time a patient will be away from work is important to enable treatment and rehabilitation planning in order to decrease the likelihood of a patient falling into long-term SA.

Patients' attitudes to sickness certification in general practice

BACKGROUND

In 2010, the sick note was replaced with the fit note, designed to enable return to work. Despite considerable research relating to general practitioners' (GPs') attitudes and practice towards the fit note, little is known regarding the patients' perspective.

AIMS

We sought to identify patients' attitudes to and feelings about the process of sickness certification.

METHODS

Patients who received fit notes were invited to participate in tape-recorded telephone interviews, which were conducted with a semi-structured approach. Participants described their reason for sickness absence and whether it had been related to work. They were then asked to provide a narrative regarding their experience of the fitness for work process and their feelings about their GP and employer's reaction to sickness absence.

RESULTS

Nine patients were interviewed. Four main themes emerged from analysis of the interviews: 'significant stigma', 'a GP who knows me', 'value of work' and 'emotional barriers'. Patients expressed preference for being seen by a familiar GP with a greater perceived understanding of the patient's attitude to sickness and work.

CONCLUSIONS

The four emergent themes of stigma, the value of work, a doctor who knows you and emotion suggest that further research should focus on the problems of stigma associated with sickness certification and patients' emotional response to asking for certification.

Recording occupation in general practice--a second cycle audit

BACKGROUND

An audit of working age patients' records in two Cornish general practices in 2012 found infrequent and inconsistent recording of patients' occupations. A concurrent survey of general practitioners (GPs) in Cornwall found that a majority of them believed it was important to do so.

AIMS

To review occupation recording in the same practices a year later and to audit a third practice, following the introduction of the electronic fit note. To repeat the survey of attitudes to recording occupation in GPs in Cornwall.

METHODS

We manually checked 300 randomly selected patient records in Practice A and electronically searched all records of working age patients (aged 16-65 years) in Practices B and C for recorded occupation. We sent an electronic survey of attitudes to recording occupation to 202 GPs in Cornwall.

RESULTS

Recording of occupation increased from 17 to 30% of records (χ(2) = 15, P < 0.001) in Practice A and from 12 to 14% (χ(2) = 16.5, P < 0.001) in Practice B. In Practice C, 1% of records had occupation recorded and coded. The proportion of GPs in Cornwall who said that it is important to records patients' occupation increased from 70 to 90% (Fisher's exact statistic 0.01, P < 0.05).

CONCLUSIONS

Recording of patients' occupation increased in both practices from 2012 to 2013, but remains infrequent and inconsistent and the very low levels in a third practice not previously audited is of concern.

Sickness certification difficulties in Ireland--a GP focus group study

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.