Interventions regarding physicians’ sickness certification practice – a systematic literature review with meta-analyses

Abstract

Objective

A variety of interventions aiming to influence physicians’ sickness certification practice have been conducted, most are, however, not evaluated scientifically. The aim of this systematic literature review was to obtain updated knowledge about interventions regarding physicians’ sickness certification practice and to summarize their possible effects, in terms of sickness absence (SA) or return to work (RTW) among patients.

Methods

We searched PubMed and Web of Science up through 15 June 2020 and selected peer-reviewed studies that reported effects of controlled interventions that aimed to improve physicians’ sickness certification practice and used SA or RTW among patients as outcome measures. Meta-analyses were conducted using random-effect models.

Results

Of the 1399 identified publications, 12 studies covering 9 interventions were assessed as relevant and included in the review. Most (70%) were from the Netherlands, two had a controlled, and seven a randomized controlled study design. All interventions included some type of training of physicians, and two interventions also included IT-support. Regarding the outcomes of SA/RTW, 30 different effect measures were used. In the meta-analyses, no statistically significant effect in favor of the interventions was observed for having any RTW (i.e. first, partial, or full) nor full RTW.

Conclusions

The individual studies showed that physicians’ sickness certification practice might be influenced by interventions in both the intended and non-intended direction, however, no statistically significant effect was indicated by the meta-analysis. The included studies varied considerably concerning intervention content and effect measures.

KEY POINTS

• The knowledge is very limited regarding the content of interventions directed to physician’s sickness certification practice

• The identified interventions included some type of training of physicians, and some of them also included IT-support for physicians

• There was a great heterogeneity among the interventions concerning effect measures used regarding return to work among patients

• The individual studies showed that physicians’ sickness certification practice might be influenced by interventions in both intended and non-intended directions, however, the overall meta-analysis did not indicate an effect.

Keywords:

• Sick leave
• return to work
• physicians’ practice patterns
• sickness certification
• intervention
• insurance medicine
• systematic review
• meta-analysis

PROSPERO registration number::

• CRD42019119697 (a revised protocol is under assessment after submission 4 September 2020
• delay due to the covid-19 situation)

Disclosure statement

No potential conflict of interest was reported by the author(s).

Patient and public involvement

Patients and/or public were not involved in the design of this study

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data from 12 scientific publications have been used.

Additional information

Funding

This project was funded by the Doctoral School in Health Care Sciences at Karolinska Institutet.