Abstract
BackgroundIn the period 2004–2009, national and regional initiatives were developed in Sweden to improve the quality of sickness certificates. Parameters for assessing the quality of sickness certificates in primary health care have been proposed. The aim of this study was to measure the quality of sickness certification in primary health care by means of assessing sickness certificates issued between 2004 and 2009 in Stockholm.MethodsThis was a retrospective study using data retrieved from sickness certificates contained in the electronic patient records of 21 primary health care centres in Stockholm County covering six consecutive years. A total number of 236 441 certificates were used in the current study. Seven quality parameters were chosen as outcome measures. Descriptive statistics and regression models with time, sex and age group as explanatory variables were used.ResultsDuring the study period, the quality of the sickness certification practice improved as the number of days on first certification decreased and the proportion of duly completely and acceptable certificates increased. Assessment of need for vocational rehabilitation and giving a prognosis for return to work were not significantly improved during the same period. Time was the most influential variable.ConclusionsThe quality of sickness certification practice improved for most of the parameters, although additional efforts to improve the quality of sickness certificates are needed. Measures, such as reminders, compulsory certificate fields and structured guidance, could be useful tools to achieve this objective.
Highlights
In the period 2004–2009, national and regional initiatives were developed in Sweden to improve the quality of sickness certificates
Between 2004 and 2009, there were national and regional initiatives in place to help health care providers handle their responsibility for issuing sickness certificates (Table 1)
Changes in quality over time The median number of days of sick leave on the first sickness certificate issued by a primary health care centre (PHCC) was reduced from 19 to 14 during the study period (Table 3 and Figure 1)
Summary
In the period 2004–2009, national and regional initiatives were developed in Sweden to improve the quality of sickness certificates. Parameters for assessing the quality of sickness certificates in primary health care have been proposed. The aim of this study was to measure the quality of sickness certification in primary health care by means of assessing sickness certificates issued between 2004 and 2009 in Stockholm. Sickness certificates issued by physicians are mandatory after one week of self-certification, when a person applies for benefits due to sickness in Sweden. All physicians in Sweden are obliged to issue these certificates. Between 2004 and 2009, there were national and regional initiatives in place to help health care providers handle their responsibility for issuing sickness certificates (Table 1). There has been much focus on the quality of the certificates issued by physicians.
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