| 1. |
- Lofgren, A, et al.
(författare)
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How physicians have learned to handle sickness-certification cases
- 2011
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 39:3, s. 245-254
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sickness absence is a common ‘‘prescription’’ in health care in many Western countries. Despite the significance of sick-listing for the life situation of patients, physicians have limited training in how to handle sickness-certification cases and the research about sickness-certification practices is scarce. Aim: gain knowledge on physicians’ learning regarding management of sickness certification of patients in formal, informal, and non-formal learning situations, respectively, and possible changes in this from 2004 to 2008. Methods: Data from two comprehensive questionnaires to physicians in Sweden about their sickness-certification practice in 2004 (n = 7665) and 2008 (n = 36898); response rates: 71% and 61%, respectively. Answers from all the physicians ≤64 years old and who had sickness certification tasks (n = 4019 and n = 14210) were analysed. Outcome measures: ratings of importance of different types of learning situations for their sickness-certification competence. Results: Few physicians stated that formal learning situations had contributed to a large or fairly large extent to their competence in sickness certification, e.g. undergraduate studies had done that for 17%, internship for 37%, and resident training for 46%, respectively. Contacts with colleagues had been helpful for 65%. One-third was helped by training arranged by social insurance offices. There was a significant increase between 2004 and 2008 in all items related to formal and non-formal learning situations, while there were no changes regarding informal learning situations. Conclusions: This study of all physicians in Sweden shows that physicians primarily attain competence in sickness certification in their daily clinical practice; through contacts with colleagues and patients.
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| 2. |
- Ropponen, A, et al.
(författare)
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Health-related risk factors for disability pensions due to musculoskeletal diagnoses: a 30-year Finnish twin cohort study
- 2011
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 39:8, s. 839-848
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Tidskriftsartikel (refereegranskat)abstract
- Aims: There is a need to better understand work incapacity due to musculoskeletal disorders (MSD) and the factors that contribute to being granted disability pension (DP) with such disorders. A twin cohort study would serve a powerful tool responding to this knowledge gap by providing information on factors affecting DP when controlling for family background. The purpose was to investigate the incidence of and risk factors for DP due to any MSD ( n = 1,819) and specifically due to osteoarthritis (OA, n = 677) in a twin cohort of 24,043 people over a 30-year follow-up. Methods: Data on twin pairs from a mailed questionnaire during the baseline year of 1975 were followed up with register data regarding DP, emigration, old-age pension, and death. For statistical analysis, univariate and multivariate Cox proportional hazard ratios were estimated. Results: Baseline musculoskeletal pain, frequency of use of analgesics, body mass index, and chronic diseases, as well as education and social class were significant risk factors for DP due to MSD at follow-up in both sexes. These factors were also the significant predictors of DP due to OA in men. In women, DP due to OA was best predicted by baseline musculoskeletal pain and lower social class. Conclusions: The risk of DP due to MSD and OA seemed to be influenced by comorbidities, educational level and social class. Analyses of twin pairs discordant for DP confirmed the results. Accumulated health problems and chronic conditions during the life course may lead to permanent work incapacity.
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| 3. |
- Svedberg, P, et al.
(författare)
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Does multidisciplinary assessment of long-term sickness absentees result in modification of sick-listing diagnoses?
- 2010
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 38:6, s. 657-663
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim was to study whether sick-leave diagnoses of long-term sickness absentees were modified after a multidisciplinary assessment and if modifications differed with type of medical specialty of the latest physician to sick-list the patient. Methods: A sample of 635 long-term sickness absentees referred to a multidisciplinary assessment by Social Insurance Offices was included. Data were obtained through sickness certificates and medical records. Patients were examined by board-certified specialists in psychiatry, orthopaedic surgery, and rehabilitation medicine. Descriptive statistics were used. Results: The multidisciplinary assessment resulted in an increase from 1—2 to 2—3 diagnoses for most patients. Forty-five per cent of the male and 47% of the female patients had only somatic diagnoses at referral. After the multidisciplinary assessment these percentages were 20% and 29%, respectively. The rate of women and men given both psychiatric and somatic diagnoses increased from 30% at referral to about 55%. The shift from either only psychiatric or only somatic diagnoses to having these diagnoses in combination was associated with type of specialty of the physician who had sick-listed the patient. Conclusions: The study indicates that many patients on long-term sick-leave with unclear diagnoses may suffer from unrecognized, and therefore probably untreated, medical disorders and co-morbidity.
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