Occupational health physicians have better work conditions for handling sickness certification compared with general practitioners: Results from a nationwide survey in Sweden

Ljungquist, Therese; Alexanderson, Kristina; Kjeldgård, Linnea; Arrelöv, Britt; Nilsson, Gunnar

doi:10.1177/1403494814558151

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…This can possibly improve continuity of care in primary healthcare settings. OHS physicians are seen as better positioned to evaluate the need for sickness absences than general practitioners working in other settings [26,27], and early consultation with an OH physician has been found effective in reducing the total number of sickness absence days taken by individuals who are at risk of sickness absences [28]. With a simple educational intervention combined with an electronic reminder, data indicate that occupational health physicians in 11 intervention clinics changed their practice of recording work-relatedness and potential for work disability.…”

Section: Discussionmentioning

confidence: 99%

Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

Atkins

Reho

Talola

et al. 2020

Trials

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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.

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Section: Discussionmentioning

confidence: 99%

Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

Atkins

Reho

Talola

et al. 2020

Trials

View full text Add to dashboard Cite

show abstract

“…Identification of patients with risk of disability enables follow-up with the OH team and early intervention in issues that might threaten work ability, and can possibly improve continuity of care in primary healthcare settings. OHS physicians are seen as being better positioned to evaluate sickness absences than general practitioners in other settings (25,26). Early consultation with OH physician has been found effective in reducing total sickness absence days in individuals at risk of sickness absences (27).…”

Section: Discussionmentioning

confidence: 99%

Improved recording of work relatedness during patient consultations in occupational primary health care: A cluster randomized controlled trial using routine data

Atkins

Reho

Talola

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Prolonging working careers is a key policy goal 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 pensions. Impacting on the trajectory between illness and work disability requires continuity of care, enabled through identifying those at risk and their follow-up. We aimed to determine whether a combined educational and electronic reminder system could improve the recording of patient primary healthcare visits and follow-up of patients at risk of work disability or with work related illnesses in occupational health care, and through this, to impact on sickness absence rates. Methods: This study is a pragmatic cluster randomized controlled trial using medical record data. An occupational primary healthcare provider’s units in Finland were randomized into an intervention group consisting of both education and electronic reminders, and a control group with usual care using minimization methods. Data on patient visits were extracted from routine patient registers collected by Pihlajalinna Työterveys from 2015 to 2017. Process indicators were collected from the electronic system. Data were cleaned and analysed intention-to-treat using ANCOVA. Results: There was no significant difference between intervention and control sites in terms of sickness absences of different duration. Process indicators suggested that there was a change in physicians’ practice following the educational component of the intervention. Conclusion: Education with an electronic reminder can change physicians’ practice, but longer term follow-up is needed to determine whether this impacts on patients’ sickness absences.

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“…Apart from lifting a burden from the physicians' shoulders such specialized teams might contribute to a higher degree of quality and equity in assessments of work ability which was one of the aims of the reform in 2005. According to a Swedish survey [30] occupational health physicians have work situations that are more favourable compared to GPs regarding sickness certifications. Further, they have high professional competence for assessment of patients' work capacity and organizational support for their work.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

Boström

Starzmann

Östberg

2020

Scandinavian Journal of Primary Health Care

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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 V€ astra G€ otaland, 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 clearcut 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 POINTS In 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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Occupational health physicians have better work conditions for handling sickness certification compared with general practitioners: Results from a nationwide survey in Sweden

Cited by 10 publications

References 30 publications

Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data

Improved recording of work relatedness during patient consultations in occupational primary health care: A cluster randomized controlled trial using routine data

Primary care physicians’ concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

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