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Primary care physicians' concerned voices on sickness certification after a period of reorganization. Focus group interviews in Sweden

Journal article
Authors Kristina Bengtsson Boström
Karin Starzmann
Anna-Lena Östberg
Published in Scandinavian Journal of Primary Health Care
Pages 10
ISSN 0281-3432
Publication year 2020
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 10
Language en
Keywords Focus group interviews, physicians, primary health care, qualitative, research, sick leave, sickness certification, primary-health-care, difficulties, diagnoses, quality, leave, Health Care Sciences & Services, General & Internal Medicine
Subject categories Family Medicine


Objective: This study explored the views of primary health care (PHC) physicians on sickness certification after reforms in 2005 prompted by the Swedish government to increase the quality and decrease the inequalities, and costs of sickness certification. Design: Qualitative design with focus group interviews. Data were analysed using qualitative content analysis. Setting: Urban and rural PHC centres in Region Vastra Gotaland, Sweden. Subjects: GPs, interns, GP trainees and locums working in PHC centres 2015. Six focus group interviews with 28 physicians were performed. Main outcome measures: Experiences and reflections about the sickness certification system. Results: The latent content was formulated in a theme: 'The physicians perceived the sickness certification process as emotive and a challenge to master with differing demands and expectations from authorities, management and patients'. Sickness certification could be easy in clear-cut situations or difficult when other factors besides the pure medical were ruling the decisions. The physicians' coping strategies for the task included both active measures (cooperation with health care staff and social insurance officers) and passive adaptation (giving in or not caring too much) to the circumstances. Proposals for the future were to transfer lengthy sickness certifications and rehabilitation to specialized teams and increase cooperation with rehabilitation coordinators and social insurance officers. Conclusions: Political decisions on laws and regulations for sickness certification impacted the primary health care making the physicians' work difficult and burdensome. Their views and suggestions should be carefully considered in future organization of primary care.

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