BACKGROUND: In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS) deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP) and orthopaedic surgeons (OS). METHODS: A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years) Odds ratios were calculated. RESULTS: A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO). To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. CONCLUSION: Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent, and they used different coping strategies to handle the problems.
OBJECTIVE: To investigate diagnosis-specific sick leave as a risk marker for subsequent disability pension. DESIGN: A prospective population based cohort study. Exposure to a new medically certified sick leave episode of more than seven days by diagnosis during 1985 was examined in relation to incident cause-specific disability pension through 1996. PARTICIPANTS: The total non-retired population of one Swedish county aged 16 to 49 years, alive and not in receipt of a disability pension at the end of 1985 (176 629 persons; 51% men). MAIN RESULTS: To eliminate confounding by sick leaves that translate into a disability pension, the follow up period for disability pension was started five years after the assessment of sick leave. After adjustment for demographic characteristics, the risk of disability pension from mental disorders was 14.1 times higher (95% confidence interval (CI), 12.1 to 16.4) for those with sick leave for mental disorders than for those with no sick leave. The corresponding hazard ratio for sick leave and disability pension within diagnostic category was 5.7 (95% CI, 5.3 to 6.2) for musculoskeletal diseases and 13.0 (7.7 to 21.8) for gastrointestinal diseases. Irrespective of diagnoses, the hazard ratio for sick leave and disability pension was 3.0 (2.9 to 3.1). CONCLUSIONS: Sick leave may provide an important risk marker for identifying groups at high risk of a disability pension, especially for psychiatric diagnoses.
OBJECTIVE: To study the frequency and nature of problems associated with physicians' sickness certification practices. DESIGN: Cross-sectional questionnaire study. SETTING: Stockholm and Ostergötland Counties in Sweden. SUBJECTS: Physicians aged
AIM: The aim of the study was to assess excess mortality related to disability pension (DP) status and DP diagnoses in Norway and Sweden during 1990-96. METHODS: Representative samples of the population aged 30-59 years, without DP at baseline 1 January 1990, 71,293 women and 76,928 men from Norway, and 68,181 women and 71,950 men from Sweden, were followed up during 1990-96. Granting of DP, DP diagnosis, age and gender were explanatory variables in Cox proportional hazards analysis with death from all causes as the outcome variable. RESULTS: Among women, 10.4% in Sweden and 7.1% in Norway obtained DP, as compared to 7.5% and 5.6% of the men. In Sweden, 66% of female and 49% of male DP recipients had musculoskeletal diagnoses, as compared to 40% and 27% in Norway. In Sweden, 3.0% of the women and 6.1% of the men with DP died, as compared to 4.6% and 8.5% in Norway. Hazard ratios (HRs) for women with DP vs. the non-DP group were 3.2 (95% confidence interval (CI)=2.7-3.8) in Sweden, and 4.9 (95% CI=4.1-5.7) in Norway. Among men with DP, there was no difference in mortality rate between the countries. HRs for men with musculoskeletal diagnoses vs. the non-DP group were 1.5 (95% CI= 1.1-2.0) in Norway and 1.4 (95% CI= 1.1-1.8) in Sweden. In both countries, the mortality rate among female disability pensioners with musculoskeletal diagnoses was not increased. CONCLUSIONS: The study confirmed an increased mortality rate among disability pensioners, except for women with musculoskeletal diagnoses. The mortality pattern related to DP diagnoses was similar in the two countries. A high frequency of musculoskeletal DP diagnoses among women with DP in Sweden explained a lower mortality rate as compared to Norway.
AIMS: In Sweden, the Social Insurance Offices each year refer long-term sickness absentees to comprehensive investigations to clarify medical conditions. However, there is a lack of scientific knowledge about these patients and their morbidity. The aim was to characterize a population of these sickness absentees regarding prevalence of somatic and psychiatric diagnoses and possible associations with sociodemographic, lifestyle, and health characteristics. METHODS: A cross-sectional study was made up of 635 sickness absentees below the age of 64, who the local Social Insurance Offices in Stockholm County, Sweden, referred to a special unit for multidisciplinary investigation. Data was obtained from questionnaires and medical records. The patients were examined by board certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Relative risks were estimated by use of modified Poisson regression to assess the associations between characteristics and diagnose outcomes. RESULTS: About 80% of the patients had more than one diagnosis. The vast majority had a psychiatric diagnosis, and approximately 55% had that in combination with at least one somatic diagnosis. An increased risk for being given a psychiatric diagnosis was found for men and unemployed people. In addition, lack of social life and friends and self-reported mental health problems were associated with psychiatric diagnoses but also among those who were given somatic diagnoses in combination with psychiatric diagnoses. Increased risks for somatic diagnoses were found for women and for patients with a higher education. CONCLUSIONS: Long-term sickness absentees referred to multidisciplinary investigations display high co-morbidity of psychiatric and somatic diagnoses and are a heterogeneous group with diverse sociodemographic and medical characteristics.
OBJECTIVES: Several studies have shown increased mortality among disability pensioners. This study attempted to determine the causes of such an increase. METHODS: A population-based study was carried out with 148,942 persons followed between 1990 and 1996 in Norway. Of this total, 6285 women and 4113 men [corrected] were on a disability pension at baseline. A Cox proportional hazards analysis was carried out separately for the women and men in which all-cause mortality was the outcome variable. Disability pension status, disability pension diagnosis, age, educational level, and mean annual income were entered as explanatory variables. RESULTS: Persons on a disability pension had a strongly increased mortality rate. The age-adjusted hazard ratio was 3.0 [95% confidence interval (95% CI) 2.4-3.8] for the women and 3.4 (95% CI 2.8-4.1) for the men on a disability pension, when they were compared with those not on a disability pension. When adjusted for education and income levels, the hazard ratios (HR) decreased significantly for the men, to 2.0 (95% CI 1.8-2.4), but not so for women (HR 2.5, 95% CI 2.2-2.9). Except for the men with musculoskeletal diagnoses, all of the diagnostic groups had hazard ratios above unity also after the adjustments were made. CONCLUSIONS: The study confirmed high early mortality among Norwegian disability pensioners in the period 1990-1996. The medical condition seemed to contribute more to the increased mortality among the women, whereas a low socioeconomic status was more important for the men.
Erratum In: Scand J Work Environ Health. 2009 Jul;35(4):319
OBJECTIVES: To quantify the extent of emotionally straining sick-listing problems among three categories of physicians and find associations with workplace characteristics. METHODS: A questionnaire was answered by 3997 physicians (response rate: 71%). RESULTS: A larger proportion of physicians at orthopaedic clinics and, in particular, at Primary Health Care Centres (PHCCs), experienced sick-listing problems, compared to physicians at other clinics. Ten percent of PHCC physicians felt threatened by patients, at least once per month, in relation to sickness certification or worried about getting reported to the disciplinary board. PHCC physicians found sick-listing more problematic compared to others (OR 4.9; 95% CI 4.1-6.0). Having a workplace policy on sick-listing was associated with a reduced risk of experiencing several problems (OR 0.5-0.6, P