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How primary health care physicians make sick listing decisions: The impact of medical factors and functioning
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2008 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, BMC Fam Pract, ISSN 1471-2296, Vol. 9, 3:1-9 p.Article in journal (Refereed) Published
Abstract [en]

Background: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. Methods: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. Results: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. Conclusion: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.

Place, publisher, year, edition, pages
2008. Vol. 9, 3:1-9 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-13897DOI: 10.1186/1471-2296-9-3ISI: 000254051200001PubMedID: 18208594OAI: oai:DiVA.org:uu-13897DiVA: diva2:41667
Available from: 2008-08-07 Created: 2008-08-07 Last updated: 2017-12-11Bibliographically approved
In thesis
1. To be or not to be Sick Certified with Special Reference to Physician and Patient Related Factors
Open this publication in new window or tab >>To be or not to be Sick Certified with Special Reference to Physician and Patient Related Factors
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives The aim of this thesis was to assess the importance of general practitioners (GP) and patient related factors for the GPs’ decision to sick certify or not to sick certify the patients.

Study population and methods The data were obtained from a cross-sectional questionnaire study of GP-patient consultations. 65 GPs responded to one questionnaire about themselves and one questionnaire about each of the altogether 642 consultations. The patients responded to a questionnaire about themselves and the consultation, altogether 521 consultations. Various combinations of the three questionnaires were used in the four papers on which this thesis is based.

Results Among GPs, long experience of family medicine and working part-time were significant determinants for issuing more sick leave certificates. Complaints perceived as clearly somatic by the physician decreased the chance of sick certifications, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the chance of sick certification, as did appointments for loco-motor complaints. Among work related factors, high ‘authority over decisions’ and high ‘social support’ were associated with reduced sickness certification probability. Worrying about illness or injury risks from work increased sickness certification. GPs and their patients took a fairly similar view to statements on health related and insurance system related matters. GPs’ opinions seem to have a greater impact than patients’ on the GPs’ decision to sickness certify a patient or not.

Conclusions A number of patient and GP related factors were associated with the probability of getting sick certified. The patient’s own judgement of impaired work ability was important for sickness certification, but a shared judgement and decision between the GP and the patient appears probable in most cases.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 80 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 535
Keyword
sick leave, absenteeism, primary care, family medicine, consultation, professional competence, work capacity, work strain, work demands, authority over decisions, social support, attitude.
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-120559 (URN)978-91-554-7747-9 (ISBN)
Public defence
2010-05-03, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:15 (Swedish)
Opponent
Supervisors
Projects
Försäkringsmedicin
Available from: 2010-04-09 Created: 2010-03-14 Last updated: 2010-04-09Bibliographically approved

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Svärdsudd, KurtAndersson, Dan K G

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