Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden

Abstract

ObjectivesDiagnoses-specific sickness certification guidelines were recently introduced in Sweden. The aim of this study was to investigate to which extent general practitioners (GPs) used these guidelines and how useful they found them, 1 year after introduction.DesignA cross-sectional questionnaire study. A comprehensive questionnaire about sickness certification practices in 2008 was sent to all physicians living and working in Sweden (n=36 898, response rate 60.6%). In all, 19.7% (n=4394) of the responders worked as GPs.SettingPrimary healthcare in all Sweden.ParticipantsThe participating GPs who had consultations concerning sickness certification at least a few times a year (n=4278, 97%).Main outcome measuresDescriptive statistics and prevalence ratios for the 11 questionnaire items about the use and usefulness of the sickness certification guidelines.ResultsA majority (76.2%) of the GPs reported that they used the guidelines. In addition, 65.4% and 43.5% of those GPs reported that the guidelines had facilitated their contacts with patients and social insurance officers, respectively. The guidelines also helped nearly one-third (31.5%) of the GPs to develop their competence and improve the quality of their management of sickness certification consultations (33.5%). About half experienced some problems when using the guidelines and 43.7% wanted better competence in using them. A larger proportion of non-specialists and of GPs with fewer sickness certification consultations had benefitted from the guidelines.ConclusionsThe national sickness certification guidelines implemented in Sweden were widely used by GPs already a year after introduction. Also, the GPs consider the guidelines useful in several respects, for example, in patient contacts and for competence development.

Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden

“…A request for an active participating patient in order to manage sickness certifications was identified, which agrees with the guidelines [27]. While patients own understanding of the need for sick leave guided the physician regarding sickness certification before the guidelines [21], our findings suggest that physicians today use the guidelines to communicate with patients, which is in line with a recently published study [30]. However, we also found that physicians sometimes do not fully trust their patients.…”

“…The general principles include recommendations regarding required documentation in sickness certificates, the assessment of work ability as a tool for intervention, patient participation, early commitment, contact with the workplace, and assessing functioning and work ability related to work demands and possible work modifications [27]. Recent surveys conducted in Sweden showed that a majority of physicians perceive the guidelines as being useful, primarily in communication with patients [30]; however, physicians still experience work ability assessments as being difficult [31]. In the United Kingdom, sharing the sickness certification responsibility is part of the fitness for work initiative, which aims to develop the roles of the key members of the PHC team [28] and the NICE guidance on long-term sick leave provides opportunities for other healthcare professionals to assist in early return to work [32].…”

Trajectories of antidepressant medication use in individuals before and after being granted disability pension due to common mental disorders- a nationwide register-based study

“…On the other hand, 20–60% of the individuals, depending on the trajectory groups, did not receive any specialized mental healthcare during 3 years prior to DP. This is not in accordance with the Swedish sick-leave guidelines [54], stating that all patients on sickness absence due to depression for more than 6 months, should be referred to a specialist. This may indicate that these individuals might have not received optimal treatment during the pre-DP years, leading to further worsening of work capacity and later resulting in exclusion from the labour market by being granted DP [16].…”

A study to examine the influence of health professionals’ advice and support on work capacity and sick leave after breast cancer surgery

“…The recommendation is 3 weeks of sick leave after breast conserving and sentinel node surgery and up to 6 weeks after mastectomy or extended axillary clearance [5], depending on the work demands of the specific work the woman has. During postoperative chemotherapy, work capacity is often reduced and sickness absence for this time period is suggested, although radiation therapy and hormonal treatment more seldom result in reduced work capacity requiring full time sick leave [5,6]. The Board of Health and Welfare has stated that sickness certification is an active measure equivalent to other healthcare recommendations and treatments and that the sickness certification should be combined with support and advice in order for the individual to be able to use their work capacity (if any) despite limitations.…”