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

Abstract

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 V€ astra G€ otaland, 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 clearcut 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. KEY POINTS In 2005 Swedish government introduced reforms to decrease the inequalities and costs of sickness certification and facilitate the physicians' work. Focus group interviews with Swedish primary care physicians revealed that sickness certification was challenging due to differing demands from authorities, management and patients. Coping strategies for the sick-listing task included both active measures and passive adaptation to the circumstances. A proposal for future better working conditions for physicians was to transfer lengthy sickness certifications and rehabilitation to specialized teams.

GPs' experiences of a collaborative care model for patients with common mental disorders who need sick leave certification: a qualitative study

“…A recent article raised the issue that the support from rehabilitation coordinators varies between PCCs, and the authors concluded that this might mean that the quality of care becomes unequal. 20 The rehabilitation coordinator working autonomously was perceived positively by most of the participants. However, some GPs indicated that collaboration would improve further if doctors were more engaged in the patient's situation; for example, by participating in the person-centred meeting with the employer.…”

“…It seemed that collaborative work was person-dependent, which was also confirmed by physicians in an earlier study. 20 Individual factors — for example, the willingness to collaborate and mutual trust among the professionals — were considered to be of even greater importance than systemic and organisational structures. 21 – 23 …”

“…Similar results were shown in previous studies evaluating GPs’ experiences of how the role of the rehabilitation coordinator worked in actual work situations at the PCC. 10 , 30 In addition, physicians in a recent focus group study 20 requested more time for medical tasks and wanted less of their time to be spent on handling difficult sickness leave certifications and insurance policy questions.…”

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

“…knowledge, skills, and attitudes) concerning sickness certification/insurance medicine, problems in handling the two roles as the patient’s treating physician and as a medical expert writing certificates, managing disagreements with patients regarding the need for SA, and cooperating with other actors in SA cases [ 9–11 ]. In addition, political decisions on laws and regulations for medical SA can be aggravating aspects for physician’s sickness certification practice [ 20 ]. Physicians have also expressed the need for more competence and organisational requisites, including support regarding management of sickness certification tasks [ 16 , 21–24 ].…”

Promoting health literacy and sense of coherence in primary care patients with long-term impaired work ability—a pilot study

“…Long-term health-related inability to work is a major problem in Sweden despite reduction efforts, and return-to-work rates from long-term illness are very low [ 1 ]. Findings from previous research are complex, as fewer symptoms and increased well-being are not necessarily associated with reduced sickness absence [ 2 ], non-medical factors may influence sickness certification [ 3 ], and educating physicians in sickness certification practice has not shown robust effects on return-to-work rates [ 4 ].…”