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The quality of the sickness certificate. A case control study of patients with symptom and disease specific diagnoses in primary health care in Sweden

Journal article
Authors Karin Starzmann
Per Hjerpe
Kristina Bengtsson Boström
Published in Scandinavian Journal of Primary Health Care
Volume 37
Issue 3
Pages 319-326
ISSN 0281-3432
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 319-326
Language en
Keywords Sick leave certification, general practice, diagnoses, medically unexplained symptoms, guideline, disability, frequency, leave, Health Care Sciences & Services, General & Internal Medicine
Subject categories Public health science


Objective: To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses. Design: Retrospective case control study 2013-2014. Setting: Primary health care, Sweden. Subjects. Patients with new onset sickness certificates with symptom diagnoses n = 222, and disease specific diagnoses (controls), n = 222. Main outcome measures: Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans. Results: Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, p = 0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days p = 0.018) and more certificates issued by telephone (23% vs. 15% p = 0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, p < 0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, p < 0.001), but less follow-up (16% vs. 26%, p < 0.008). In both groups contacts related to rehabilitation and with employers were scarce. Conclusion: Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing.

Page Manager: Webmaster|Last update: 9/11/2012

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