Background
Method
Measures
Type of clinic
Frequency of sickness certification
Frequency of issuing sickness certificates for longer periods than actually would be necessary
Organizational support
Clinical experiences of sickness certification
Perceived problems
Need for more competence
Statistical analysis
Results
Study sample characteristics
Have sickness certification consultations | |||
---|---|---|---|
1-5 times a week | More than 6 times a week | ||
N (%) | N (%) | N (%) | |
Child and youth | 116 (1.0) | 90 (77.6) | 26 (22.4) |
Dermatology | 53 (0.5) | 46 (86.8) | 7 (13.2) |
Ear, nose, and throat | 359 (3.1) | 264 (73.5) | 95 (26.5) |
Eye | 89 (0.8) | 76 (85.4) | 13 (14.6) |
Gynecology | 746 (6.1) | 462 (61.9) | 284 (38.1) |
Infection | 265 (2.3) | 198 (74.7) | 67 (25.3) |
Internal medicine | 1387 (12.0) | 972 (70.1) | 415 (29.9) |
Neurology | 226 (2.0) | 119 (52.7) | 107 (47.3) |
Occupational health | 463 (4.0) | 101 (21.8) | 362 (78.2) |
Oncology | 316 (2.7) | 82 (25.9) | 234 (74.1) |
Orthopedic | 865 (7.5) | 180 (20.8) | 685 (79.2) |
Pain | 78 (0.7) | 20 (25.6) | 58 (74.4) |
Primary health care | 4053 (35.1) | 2234 (55.1) | 1819 (44.9) |
Psychiatry | 1024 (8.9) | 363 (35.4) | 661 (64.6) |
Rehabilitation | 155 (1.3) | 48 (31.0) | 107 (69.0) |
Rheumatology | 181 (1.6) | 88 (48.6) | 93 (51.4) |
Surgery | 1176 (10.2) | 665 (56.5) | 511 (43.5) |
ALL
| 11583 (100) | 6008 (52.0) | 5544 (48.0) |
Frequency of issuing sickness certificates for longer periods than necessary
Factors associated with extended sickness certificates
Frequency of the following situations related to sickness certification | Perceived problems regarding sickness certification | |||||||
---|---|---|---|---|---|---|---|---|
Delicate interactions with patients | Lack of time | Collaboration, referrals, and support | Need for more competence | Problems following guidelines | General problems | Problems with assessment | Problems with patient contacts | |
(min = 0; max = 4) | (min = 0; max = 4) | (min = 0; max = 4) | (min = 0; max = 3) | (min = 0; max = 3) | (min = 0; max = 3) | (min = 0; max = 3) | (min = 0; max = 3) | |
M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | M (SD) | |
Child and youth | 0.40 (0.41) | 2.53 (1.10) | 0.33 (0.33) | 1.22 (0.60) | 2.03 (1.27) | 1.06 (0.68) | 1.13 (0.66) | 0.90 (0.66) |
Dermatology | 0.50 (0.43) | 2.31 (1.33) | 0.49 (0.37) | 1.35 (0.59) | 1.62 (1.29) | 1.50 (0.83) | 1.42 (0.75) | 1.25 (0.74) |
Ear, nose, and throat | 0.43 (0.34) | 2.30 (1.29) | 0.33 (0.33) | 1.22 (0.60) | 2.14 (1.20) | 1.13 (0.73) | 1.29 (0.74) | 1.11 (0.73) |
Eye | 0.50 (0.47) | 2.45 (1.23) | 0.20 (0.22) | 1.11 (0.58) | 1.94 (1.28) | 1.26 (0.87) | 1.26 (0.71) | 1.17 (0.79) |
Gynecology | 0.65 (0.49) | 2.40 (1.20) | 0.34 (0.29) | 1.24 (0.59) | 1.69 (1.29) | 1.16 (0.71) | 1.32 (0.69) | 1.24 (0.72) |
Infection | 0.46 (0.38) | 2.32 (1.14) | 0.28 (0.26) | 1.27 (0.51) | 2.07 (1.18) | 1.27 (0.63) | 1.46 (0.69) | 1.21 (0.68) |
Internal medicine | 0.49 (0.36) | 2.57 (1.13) | 0.38 (0.33) | 1.36 (0.57) | 1.75 (1.29) | 1.26 (0.71) | 1.52 (0.70) | 1.27 (0.69) |
Neurology | 0.55 (0.39) | 2.97 (1.03) | 0.66 (0.44) | 1.35 (0.59) | 1.99 (1.25) | 1.35 (0.72) | 1.52 (0.70) | 1.23 (0.69) |
Occupational health | 0.67 (0.44) | 2.11 (1.32) | 1.67 (0.50) | 1.24 (0.54) | 0.83 (1.08) | 0.96 (0.77) | 1.22 (0.68) | 0.90 (0.64) |
Oncology | 0.36 (0.33) | 2.55 (1.17) | 0.34 (0.31) | 1.16 (0.58) | 2.03 (1.27) | 1.06 (0.68) | 1.13 (0.66) | 0.90 (0.66) |
Orthopedic | 0.76 (0.46) | 3.04 (1.06) | 0.52 (0.34) | 1.24 (0.56) | 1.79 (1.28) | 1.43 (0.77) | 1.48 (0.69) | 1.41 (0.72) |
Pain | 0.64 (0.51) | 1.83 (1.49) | 1.04 (0.72) | 1.15 (0.65) | 1.66 (1.27) | 1.19 (0.97) | 1.35 (0.91) | 1.02 (0.83) |
Primary health care | 0.80 (0.50) | 2.96 (0.96) | 1.11 (0.46) | 1.53 (0.54) | 1.33 (1.17) | 1.61 (0.73) | 1.94 (0.69) | 1.57 (0.69) |
Psychiatry | 0.73 (0.52) | 2.73 (1.11) | 1.11 (0.61) | 1.51 (0.56) | 1.73 (1.25) | 1.32 (0.79) | 1.60 (0.75) | 1.23 (0.70) |
Rehabilitation | 0.46 (0.39) | 2.36 (1.22) | 1.56 (0.71) | 1.35 (0.55) | 1.39 (1.25) | 1.05 (0.78) | 1.16 (0.66) | 0.95 (0.66) |
Rheumatology | 0.59 (0.38) | 3.01 (0.96) | 0.69 (0.41) | 1.36 (0.59) | 1.75 (1.24) | 1.36 (0.75) | 1.60 (0.62) | 1.36 (0.68) |
Surgery | 0.50 (0.40) | 2.48 (1.23) | 0.25 (0.30) | 1.10 (0.59) | 1.87 (1.30) | 1.09 (0.76) | 1.22 (0.73) | 1.03 (0.74) |
ALL
| 0.65 (0.48) | 2.68 (1.16) | 0.75 (0.59) | 1.36 (0.60) | 1.60 (1.27) | 1.33 (0.79) | 1.55 (0.78) | 1.28 (0.75) |
Sickness absences issued for longer periods than necessary due to health care factors | Sickness absences issued for longer periods than necessary due to wait for action from other stakeholders | ||||
---|---|---|---|---|---|
Unadjusted ORa(99% CI) | MultivariatebOR (99% CI) | Unadjusted ORa(99% CI) | MultivariatebOR (99% CI) | ||
Gender
| Female | 1 | - | 1 | - |
Male | 1.06 (0.96-1.16) | - | 1.07 (0.96-1.18) | - | |
Age
| – 34 | 1 | - | 1 | 1 |
35 – 44 | 0.92 (0.79-1.06) | - | 1.47 (1.24-1.75)** | 1.26 (0.97-1.63) | |
45 – 54 | 1.00 (0.86-1.16) | - | 2.09 (1.76-2.47)** | 1.48 (1.09-2.00)* | |
55 – 64 | 1.13 (0.98-1.30) | - | 2.51 (2.14-2.95)** | 1.78 (1.30-2.44)** | |
65 – | 1.00 (0.78-1.28) | 2.23 (1.70-2.91)** | 2.18 (1.39-3.40)** | ||
Board certified specialist
| No | 1 | - | 1 | 1 |
Yes | 1.00 (0.90-1.11) | - | 1.71 (1.52-1.92)** | 1.65 (1.30-2.09)** | |
Sickness certification consultations
| |||||
1-5 times a week | 1 | 1 | 1 | 1 | |
More than 5 times a week | 2.90 (2.62-3.20)** | 1.96 (1.69-2.27)** | 2.56 (2.30-2.84)** | 1.61 (1.37-1.88)** | |
Well established workplace policy
| |||||
Yes (Reference = no) | 1.18 (1.05-1.33)** | 0.85 (0.71-1.02) | 1.56 (1.38-1.76)** | 0.94 (0.79-1.13) | |
Support from your management
| |||||
Yes (Reference = no) | 1.07 (0.97-1.18) | - | 0.99 (0.89-1.10) | - | |
Frequency of the following situations related to sickness certification:
| |||||
Delicate interactions with patients | 3.18 (2.94-3.45)** | 1.79 (1.62-1.98)** | 2.18 (2.05-2.32)** | 1.57 (1.44-1.71)** | |
Lack of time | 2.10 (1.99-2.22)** | 1.52 (1.41-1.65)** | 1.86 (1.75-1.98)** | 1.39 (1.27-1.52)** | |
Collaboration, referrals, and support | 2.47 (2.32-2.64)** | 1.62 (1.46-1.80)** | 2.80 (2.63-2.99)** | 1.78 (1.61-1.97)** | |
Need for more competence | 1.59 (1.51-1.68)** | 1.01 (0.92.-1.10) | 1.41 (1.34-1.50)** | 1.02 (0.93-1.12) | |
Perceived problems regarding sickness certification:
| |||||
Problems with the sickness certification guidelines | 0.88 (0.83-0.92)** | 1.07 (1.00-1.14) | 0.86 (0.82-0.90)** | 1.05 (0.98-1.12) | |
General problems with sickness certification | 1.87 (1.77-1.97)** | 1.17 (1.07-1.29)** | 1.62 (1.53-1.71)** | 1.04 (0.94-1.14) | |
Problems with assessments | 1.99 (1.88-2.10)** | 1.19 (1.06-1.34)** | 1.73 (1.63-1.83)** | 1.20 (1.05-1.36)** | |
Problems with patient contacts | 1.88 (1.78-1.98)** | 1.11 (0.99-1.25) | 1.57 (1.48-1.66)** | 1.10 (0.98-1.24) | |
Clinic
| |||||
Internal medicine | 1 | 1 | 1 | 1 | |
Occupational health | 7.08 (5.02-10.00)** | 4.77 (2.67-8.50)** | 9.82 (7.11-13.57)** | 2.58 (1.56-4.27)** | |
Orthopedic | 4.82 (3.75-6.19)** | 2.53 (1.86-3.46)** | 3.23 (2.43-4.29)** | 1.52 (1.08-2.15)* | |
Primary health care | 4.74 (3.99-5.63)** | 1.85 (1.45-2.35)** | 7.32 (5.84-9.17)** | 2.43 (1.81-3.26)** | |
Psychiatry | 2.62 (2.10-3.27)** | 1.04 (0.77-1.41) | 5.38 (4.12-7.03)** | 1.93 (1.37-2.73)** | |
Neurology | 2.12 (2.10-3.27)** | 1.25 (0.78-2.00) | 3.30 (2.15-5.07)** | 2.00 (1.20-3.36)* | |
Rheumatology | 1.80 (1.19-2.72)** | 0.97 (0.58-1.61) | 4.16 (2.65-6.55)** | 1.90 (1.09-3.32)* | |
Pain | 1.18 (0.62-2.26) | 0.81 (0.32-2.04) | 2.43 (1.16-5.07)* | 0.70 (0.24-2.11) | |
Rehabilitation | 1.09 (0.69-1.71) | 0.39 (0.21-0.72)** | 3.27 (1.99-5.38)** | 0.86 (0.44-1.66) | |
Surgery | 0.78 (0.63-0.97)* | 0.91 (0.69-1.19) | 0.44 (0.30-0.64)** | 0.52 (0.34-0.81)** | |
Gynecology | 0.69 (0.53-0.89)** | 0.50 (0.36-0.70)** | 0.80 (0.55-1.16) | 0.61 (0.38-0.96)* | |
Infection | 0.51 (0.34-0.76)** | 0.55 (0.34-0.90)* | 0.51 (0.26-0.98)* | 0.48 (0.21-1.10) | |
Oncology | 0.50 (0.34-0.72)** | 0.53 (0.34-0.84)** | 0.48 (0.26-0.91)* | 0.54 (0.26-1.10) | |
Child and youth | 0.47 (0.25-0.88)* | 0.60 (0.27-1.35) | 0.65 (0.26-1.64) | 0.75 (0.26-2.14) | |
Ear, nose and throat | 0.44 (0.31-0.63)* | 0.47 (0.30-0.74)** | 0.60 (0.34-1.03) | 0.52 (0.26-1.02) | |
Dermatology | 0.44 (0.18-1.06) | 0.35 (0.11-1.14) | 0.92 (0.29-2.86) | 1.21 (0.34-4.32) | |
Eye | 0.39 (0.19-0.80)** | 0.45 (0.18-1.16) | 1.10 (0.48-2.52) | 1.75 (0.67-4.56) |
Sickness certificates issued for longer periods than necessary due to patient factors | Sickness certificates issued for longer periods than necessary due to physician factors | ||||
---|---|---|---|---|---|
Unadjusted ORa(99% CI) | MultivariatebOR (99% CI) | Unadjusted ORa(99% CI) | MultivariatebOR (99% CI) | ||
Gender
| Female | 1 | 1 | 1 | - |
Male | 0.82 (0.72-0.94)** | 0.96 (0.80-1.16) | 1.12 (0.97-1.29) | - | |
Age
| – 34 | 1 | 1 | 1 | 1 |
35 – 44 | 0.84 (0.69-1.01) | 0.83 (0.65-1.07) | 0.75 (0.61-0.91)** | 0.84 (0.62-1.12) | |
45 – 54 | 0.78 (0.64-0.95)** | 0.67 (0.51-0.87)** | 0.55 (0.44-0.67)** | 0.68 (0.46-1.00) | |
55 – 64 | 0.64 (0.53-0.78)** | 0.55 (0.42-0.72)** | 0.52 (0.42-0.63)** | 0.83 (0.56-1.23) | |
65 – | 0.44 (0.30-0.66)** | 0.55 (0.32-0.93)* | 0.29 (0.18-0.47)** | 0.54 (0.26-1.10) | |
Board certified specialist
| 1 |
-
| 1 | 1 | |
Yes (Reference = no) | 0.69 (0.60-0.79) |
-
| 0.57 (0.49-0.65)** | 1.04 (0.77-1.41) | |
Sickness certification consultations
| |||||
1-5 times a week | 1 | 1 | 1 | 1 | |
More than 6 times a week | 3,29 (2.85-3.80)** | 1.91 (1.57-2.33)** | 2.35 (2.02-2.73)** | 1.57 (1.27-1.94)** | |
Well established workplace policy
| |||||
Yes (Reference = no) | 0.94 (0.80-1.10) |
-
| 0.58 (0.47-0.70)** | 0.56 (0.43-0.75)** | |
Support from your management
| |||||
Yes (Reference = no) | 1.10 (0.96-1.28) | - | 0.95 (0.82-1.10) | - | |
Frequency of the following situations related to sickness certification:
| |||||
Delicate interactions with patients | 2.52 (2.34-2.70)** | 1.74 (1.59-1.90)** | 2.88 (2.67-3.11)** | 2.12 (1.92-2.34)** | |
Lack of time | 2.04 (1.87-2.23)** | 1.42 (1.25-1.62)** | 2.22 (2.01-2.45)** | 1.34 (1.17-1.54)** | |
Collaboration, referrals, and support | 2.10 (1.96-2.24)** | 1.46 (1.30-1.64)** | 1.39 (1.30-1.49)** | 1.04 (0.91-1.19) | |
Need for more competence | 1.68 (1.56-1.81)** | 0.98 (0.88-1.10) | 1.99 (1.83-2.16)** | 1.17 (1.04-1.32)** | |
Perceived problems regarding sickness certification:
| |||||
Problems with the sickness certification guidelines | 0.91 (0.85-0.97)** | 1.06 (0.96-1.16) | 1.07 (0.99-1.15) | - | |
General problems with sickness certification | 1.73 (1.61-1.85)** | 0.99 (0.88-1.12) | 1.98 (1.84-2.15)** | 0.93 (0.82-1.06) | |
Problems with assessments | 2.10 (1.94-2.27)** | 1.28 (1.09-1.49)** | 2.40 (2.20-2.62)** | 1.09 (0.92-1.29) | |
Problems with patient contacts | 2.00 (1.86-2.15)** | 1.30 (1.12-1.50)** | 2.98 (2.72-3.26)** | 2.03 (1.73-2.38)** | |
Clinic
| |||||
Internal medicine | 1 | 1 | 1 | 1 | |
Occupational health | 4.36 (2.84-6.72)** | 2.63 (1.34-5.16)** | 1.09 (0.65-1.81) | 1.28 (0.57-2.89) | |
Orthopedic | 3.56 (2.41-5.24)** | 1.99 (1.22-3.24)** | 2.62 (1.85-3.71)** | 1.24 (0.80-1.95) | |
Primary health care | 5.52 (4.00-7.63)** | 2.51 (1.64-3.84)** | 2.70 (2.04-3.57)** | 1.30 (0.88-1.91) | |
Psychiatry | 9.50 (6.68-13.51)** | 6.10 (3.85-9.67)** | 2.22 (1.58-3.13)** | 1.37 (0.86-2.18) | |
Neurology | 1.36 (0.65-2.84) | 1.16 (0.49-2.73) | 1.15 (0.59-2-24) | 0.92 (0.40-2.14) | |
Rheumatology | 2.07 (1.03-4.16)* | 1.83 (0.83-4.06) | 1.17 (0.57-2.42) | 0.92 (0.39-2.17) | |
Pain | 2.29 (0.83-6.33) | 1.35 (0.30-6.20) | 0.93 (0.27-3.17) | 1.67 (0.37-7.51) | |
Rehabilitation | 2.69 (1.35-5.36)** | 2.30 (0.99-5.38) | 0.24 (0.05-1.12) | 0.39 (0.08-1.96) | |
Surgery | 0.56 (0.33-0.96)* | 0.72 (0.39-1.34) | 1.08 (0.74-1.58) | 1.19 (0.75-1.91) | |
Gynecology | 1.30 (0.80-2.12) | 1.22 (0.66-2.23) | 1.94 (1.33-2.83)** | 1.57 (0.96-2.58) | |
Infection | 0.77 (0.33-1.80) | 0.60 (0.18-2.00) | 0.68 (0.32-1.44) | 0.66 (0.26-1.69) | |
Oncology | 0.23 (0.06-0.86)* | 0.38 (0.09-1.52) | 0.78 (0.40-1.52) | 1.50 (0.68-3.29) | |
Child and youth | 1.04 (0.34-3.20) | 1.80 (0.46-7.03) | 0.71 (0.23-2.16) | 0.93 (0.18-4.88) | |
Ear, nose and throat | 0.56 (0.24-1.31) | 0.76 (0.28-2.03) | 0.49 (0.23-1.04) | 0.56 (0.22-1.37) | |
Dermatology | 1.52 (0.38-6.02) | 1.05 (0.13-8.67) | 0.75 (0.16-3.53) | 0.52 (0.05-5.17) | |
Eye | 1.05 (0.31-3.58) | 1.82 (0.39-8.51) | 0.87 (0.29-2.68) | 0.75 (0.14-3.91) |