Sickness certificates in Sweden: did the new guidelines improve their quality?

BMC Public Health

Birgitta Öberg¹  Elsy Söderberg²  Emma Nilsing¹ 

[1] Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden;Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden

关键词: Sweden;    Work ability;    Functioning;    Physicians;    Sick leave;    Rehabilitation;    Disability and Health (ICF);    International Classification of Functioning;    Sickness certificates;   

Others  :  1162928
DOI  :  10.1186/1471-2458-12-907

 received in 2012-05-10, accepted in 2012-10-24,  发布年份 2012

【 摘 要 】

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 Östergötland County, Sweden. Quality is defined in terms of descriptions of functioning with the use of activity and participation according to WHO’s International Classification of Functioning, Disability and Health (ICF), and in prescriptions of early rehabilitation.

Methods

During two weeks in 2007 and four weeks in 2009, all certificates had been collected upon arrival to the social insurance office in Östergötland 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.

Results

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.

Conclusions

An improvement of the quality between certificates collected in 2007 and 2009 was demonstrated in Östergötland 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.

【 授权许可】

   
2012 Nilsing et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Gimeno D, Benavides FG, Benach J, Amick BC: Distribution of sickness absence in the European Union countries. Occup Environ Med 2004, 61:867-869.
• [2]Wahlstrom R, Alexanderson K: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians’ sick-listing practices. Scand J Public Health Suppl 2004, 32(Suppl 63):222-255.
• [3]OECD: Sickness, Disability and Work: Breaking the Barriers. A Synthesis of Findings across OECD Countries. Paris: OECD Publishing; 2010.
• [4]Social insurance in figures. www.forsakringskassan.se webcite
• [5]de Boer WEL, Besseling JJM, Willems JHBM: Organisation of disability evaluation in 15 countries. Prat Organ Soins 2007, 38:205-217.
• [6]Söderberg E, Alexanderson K: Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits. Scand J Public Health 2005, 33:314-320.
• [7]Fleten N, Johnsen R, Ostrem BS: Reliability of sickness certificates in detecting potential sick leave reduction by modifying working conditions: a clinical epidemiology study. BMC Publ Health 2004, 4:8. BioMed Central Full Text
• [8]Kerstholt JH, De Boer WE, Jansen NJ: Disability assessments: effects of response mode and experience. Disabil Rehabil 2006, 28:111-115.
• [9]Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R: Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ 2004, 328:88.
• [10]von Knorring M, Sundberg L, Löfgren A, Alexanderson K: Problems in sickness certification of patients: A qualitative study on views of 26 physicians in Sweden. Scand J Prim Health Care 2008, 26:22-28.
• [11]Löfgren A, Hagberg J, Arrelöv B, Ponzer S, Alexanderson K: Frequency and nature of problems associated with sickness certification tasks: A cross-sectional questionnaire study of 5455 physicians. Scand J Prim Health Care 2007, 25:178-185.
• [12]Swartling MS, Alexanderson KA, Wahlstrom RA: Barriers to good sickness certification – an interview study with Swedish general practitioners. Scand J Public Health 2008, 36:408-414.
• [13]Osteras N, Gulbrandsen P, Benth JS, Hofoss D, Brage S: Implementing structured functional assessments in general practice for persons with long-term sick leave: a cluster randomised controlled trial. BMC Fam Pract 2009, 10:31. BioMed Central Full Text
• [14]Roope R, Parker G, Turner S: General practitioners’ use of sickness certificates. Occup Med (Lond) 2009, 59:580-585.
• [15]de Boer WE, Bruinvels DJ, Rijkenberg AM, Donceel P, Anema JR: Evidence-based guidelines in the evaluation of work disability: an international survey and a comparison of quality of development. BMC Publ Health 2009, 9:349. BioMed Central Full Text
• [16]Socialstyrelsen [National Board of Health and Welfare]: Försäkringsmedicinskt beslutsstöd - vägledning för sjukskrivning [Sick leave guidelines]. (In Swedish). Stockholm; 2007.
• [17]Socialstyrelsen [National Board of Health and Welfare]: Försäkringsmedicinskt beslutsstöd för specifika diagnoser [Sick leave guidelines for specific diagnoses] (In Swedish). Stockholm; 2012. http://www.socialstyrelsen.se/riktlinjer/forsakringsmedicinsktbeslutsstod webcite
• [18]World Health Organization: ICF - International classification of functioning, disability and health. Genève: World Health Organization; 2001.
• [19]Sveriges kommuner och landsting: Vidtagna åtgärder för att implementera det Försäkringsmedicinska beslutsstödet [Strategies for implementing the sick leave guidelines]. (In Swedish). Stockholm: Sveriges kommuner och landsting [Swedish Municipalities and Counties]; 2012. http://www.skl.se/vi_arbetar_med/halsaochvard/sjukskrivningarna/rapporter_och_publikationer_1/implementeringen_av_forsakringsmedicinska_beslutsstodet webcite
• [20]Skåner Y, Nilsson GH, Arrelov B, Lindholm C, Hinas E, Wilteus AL, Alexanderson K: Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden. BMJ Open 2011, 1:e000303.
• [21]Berwick DM: Disseminating innovations in health care. JAMA 2003, 289:1969-1975.
• [22]Grol R, Wensing M, Eccles M: Improving patient care. The implementation of change in clinical practice. Edinburgh: Elsevier; 2005.
• [23]Nutley SM, Walter I, Davies HTO: Using evidence: How research can inform public services. Bristol: The Policy Press; 2007.
• [24]Greenhalgh T, Robert G, Bate P, Macfarlane F, Kyriakidou O: Diffusion of innovations in health service organizations. A systematic literatur review. Oxford: BMJ books;
• [25]Rogers EM: Diffusion of innovations. 5th edition. New York: Free press; 2003.
• [26]Anner J, Schwegler U, Kunz R, Trezzini B, de Boer W: Evaluation of work disability and the international classification of functioning, disability and health: what to expect and what not. BMC Publ Health 2012, 12:470. BioMed Central Full Text
• [27]Geyh S, Peter C, Muller R, Bickenbach JE, Kostanjsek N, Ustun BT, Stucki G, Cieza A: The Personal Factors of the International Classification of Functioning, Disability and Health in the literature - a systematic review and content analysis. Disabil Rehabil 2011, 33:1089-1102.
• [28]Brage S, Donceel P, Falez F: Development of ICF core set for disability evaluation in social security. Disabil Rehabil 2008, 30:1392-1396.
• [29]Nilsing E, Söderberg E, Normelli H, Öberg B: Description of functioning in sickness certificates. Scand J Public Health 2011, 39:508-516.
• [30]Morgell R, Backlund LG, Arrelöv B, Strender LE, Nilsson GH: Health problems and disability in long-term sickness absence: ICF coding of medical certificates. BMC Publ Health 2011, 11:860. BioMed Central Full Text
• [31]Englund L, Tibblin G, Svardsudd K: Effects on physicians’ sick-listing practice of an administrative reform narrowing sick-listing benefits. Scand J Prim Health Care 2000, 18:215-219.
• [32]Hensing G, Alexanderson K, Allebeck P, Bjurulf P: How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Soc Med 1998, 26:133-144.
• [33]Alexanderson KA, Borg KE, Hensing GK: Sickness absence with low-back, shoulder, or neck diagnoses: an 11-year follow-up regarding gender differences in sickness absence and disability pension. Work 2005, 25:115-124.
• [34]Downe-Wamboldt B: Content analysis: method, applications, and issues. Health Care Women Int 1992, 13:313-321.
• [35]Cavanagh S: Content analysis: concepts, methods and applications. Nurse research 1997, 40:5-16.
• [36]Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G: ICF linking rules: an update based on lessons learned. J Rehabil Med 2005, 37:212-218.
• [37]Waddell G: The back pain revolution. 2nd edition. Edinburgh: Churchill Livingstone; 2004.
• [38]van Duijn M, Eijkemans MJ, Koes BW, Koopmanschap MA, Burton KA, Burdorf A: The effects of timing on the cost-effectiveness of interventions for workers on sick leave due to low back pain. Occup Environ Med 2010, 67:744-750.
• [39]Sinnott P: Administrative delays and chronic disability in patients with acute occupational low back injury. J Occup Environ Med 2009, 51:690-699.
• [40]Naidoo J, Wills J: Foundations for health promotion. 3rd edition. Edinburgh: Elsevier; 2009.
• [41]Neal D, Wood W, Quinn J: Habits - a repeat performance. Curr Dir Psychol Sci 2006, 15:198-202.
• [42]Verplanken B, Aarts H: Habit, attitude and planned behavior: Is habit an empty construct. Eur Rev Soc Psychol 1999, 10:101-134.
• [43]Löfgren A, Hagberg J, Alexanderson K: What physicians want to learn about sickness certification: analyses of questionnaire data from 4019 physicians. BMC Publ Health 2010, 10:61. BioMed Central Full Text
• [44]Rebergen DS, Bruinvels DJ, Bos CM, van der Beek AJ, van Mechelen W: Return to work and occupational physicians’ management of common mental health problems–process evaluation of a randomized controlled trial. Scand J Work Environ Health 2010, 36:488-498.
• [45]Alexanderson K, Norlund A: Swedish Council on Technology Assessment in Health Care (SBU). Chapter 1. Aim, background, key concepts, regulations, and current statistics. Scand J Public Health Suppl 2004, 32(Suppl 63):12-30.
• [46]Kersnik J: Management of sickness absence: a quality improvement study from Slovenia. Qual Health Care 1999, 8:262-269.