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

Abstract

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.

KEY POINTS

• Symptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses.

• Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses.

• Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.

Keywords:

• Sick leave certification
• general practice
• diagnoses
• medically unexplained symptoms
• guideline adherence

Acknowledgements

Ann Segerblom is cordially thanked for technical support during the study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Ethical approval

Ethical approval was granted by the Regional Ethical Review Board in Gothenburg, reg. no: 719-15.

Additional information

Funding

This study was financed by the Skaraborg research and development council, the Skaraborg primary care research and development council, and the Skaraborg Institute. Ann Segerblom is cordially thanked for technical support during the study. Ethical approval was granted by the Regional Ethical Review Board in Gothenburg, reg. no: 719-15.