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Sickness certificates in Sweden: did the new guidelines improve their quality?
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
2012 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, no 907Article in journal (Refereed) Published
Abstract [en]

Background: Long-term sickness absence is high in many Western countries. In Sweden and many other countries, decisions on entitlement to sickness benefits and return to work measures are based on information provided by physicians in sickness certificates. The quality demands, as stressed by the Swedish sick leave guidelines from 2008, included accurate sickness certificates with assessment of functioning clearly documented. This study aims to compare quality of sickness certificates between 2007 and 2009 in Ostergotland County, Sweden. Quality is defined in terms of descriptions of functioning with the use of activity and participation according to WHOs International Classification of Functioning, Disability and Health (ICF), and in prescriptions of early rehabilitation. less thanbrgreater than less thanbrgreater thanMethods: During two weeks in 2007 and four weeks in 2009, all certificates had been collected upon arrival to the social insurance office in Ostergotland County, Sweden. Four hundred seventy-five new certificates were included in 2007 and 501 in 2009. Prolongations of sick leave were included until the last date of sick listing. Free text on functioning was analysed deductively using the ICF framework, and placed into categories (body functions/structures, activity, participation, no description) for statistical analysis. less thanbrgreater than less thanbrgreater thanResults: The majority of the certificates were issued for musculoskeletal diseases or mental disorders. Text on functioning could be classified into the components of ICF in 65% and 78% of sickness certificates issued in 2007 and 2009, respectively. Descriptions according to body components such as "sensations of pain" or "emotional functions" were given in 58% of the certificates from 2007 and in 65% from 2009. The activity component, for example "walking" or "handling stress", was more frequent in certificates issued in 2009 compared with 2007 (33% versus 26%). Prescriptions of early rehabilitation increased from 27% in 2007 to 35% in 2009, primarily due to more counseling. less thanbrgreater than less thanbrgreater thanConclusions: An improvement of the quality between certificates collected in 2007 and 2009 was demonstrated in Ostergotland County, Sweden. The certificates from 2009 provided more information linkable to ICF and incorporated an increased use of activity limitations when describing patients functioning. Still, activity limitations and prescriptions of early rehabilitation were only present in one-third of the sickness certificates.

Place, publisher, year, edition, pages
BioMed Central , 2012. Vol. 12, no 907
Keyword [en]
Sickness certificates, International Classification of Functioning, Disability and Health (ICF), Rehabilitation, Sick leave, Physicians, Functioning, Work ability, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-86657DOI: 10.1186/1471-2458-12-907ISI: 000311617300001OAI: oai:DiVA.org:liu-86657DiVA: diva2:580084
Note

Funding Agencies|National Social Insurance Administration||County Council in Ostergotland, Sweden|IHS 7/0728|

Available from: 2012-12-20 Created: 2012-12-20 Last updated: 2017-12-06
In thesis
1. The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
Open this publication in new window or tab >>The Sick Leave Process: Sick Leave Guidelines, Sickness Certificates, and Experiences of Professionals
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Decisions on entitlement to sickness benefits and return to work interventions have substantial impact on individuals’ lives and on society. In most Western European countries, such decisions are based on sickness certificates, which should provide information on how a disease or injury reduces the individual’s work ability. These are challenging and complex assessments. In 2008, guidelines for the management of sick leave were implemented in Sweden, emphasizing early assessments of work ability and return to work, and increasing the quality demands of sickness certificates by underscoring descriptions of activity limitations related to work. The overall aim of this thesis was to gain a deeper knowledge of the sick leave process with special emphasis on the content of sickness certificates and primary health care (PHC) professionals’ experiences with the process. Specific aims were to compare the quality of sickness certificates regarding descriptions of functioning by the use of WHO’s International Classification of Functioning, disability, and health (ICF), as well as the prescribed interventions before versus after implementation of the Swedish sick leave guidelines.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

The thesis comprises three studies. A cross-sectional design was used in studies I and II, which included 475 and 501 new sickness certificates consecutively collected in Östergötland County, Sweden, in 2007 and 2009, respectively. Text on functioning was analysed with a deductive content analysis using the ICF. Study III was an exploratory study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals (n=18) in Östergötland County. An inductive content analysis was used in this study.

An overall conclusion drawn from this thesis is that patient functioning and needs might not be adequately communicated in the sick leave process. Despite the implementation of sick leave guidelines, this information is limited in sickness certificates and the collaboration is poor among the involved stakeholders, i.e., health care, the social insurance office, the employer and the OHS. The basis for decisions on entitlement to sickness benefits could be improved by including a description of the patients’ activity limitations or participation restrictions related to work demands. One way to enhance the decision basis might be to use the available team competencies at the PHC.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1354
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89838 (URN)978-91-7519-689-3 (ISBN)
Public defence
2013-04-05, Aulan, Hälsans Hus ingång 16, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-08 Created: 2013-03-08 Last updated: 2013-03-08Bibliographically approved

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Nilsing, EmmaSöderberg, ElsyÖberg, Birgitta

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