Fleten Nils, Johnsen Roar, Østrem Bente Skipenes
Department of Community Medicine, University of Tromsø, Tromsø, N-9037, Norway.
BMC Public Health. 2004 Mar 25;4:8. doi: 10.1186/1471-2458-4-8.
Medical sickness certificates are generally the main source for information when scrutinizing the need for aimed intervention strategies to avoid or reduce the individual and community side effects of sick leave. This study explored the value of medical sickness certificates related to daily work in Norwegian National Insurance Offices to identify sick-listed persons, where modified working conditions might reduce the ongoing sick leave.
The potential for reducing the ongoing sick leave by modifying working conditions was individually assessed on routine sickness certificates in 999 consecutive sick leave episodes by four Norwegian National Insurance collaborators, two with and two without formal medical competence. The study took place in Northern Norway in 1997 and 1998. Agreement analysed with differences against mean, kappa, and proportional-agreement analysis within and between groups of assessors was used in the judgement. Agreements between the assessors and the self-assessment of sick-listed subjects were additionally analysed in 159 sick-leave episodes.
Both sick-listed subjects and National Insurance collaborators anticipated a potential reduction in sick leave in 20-30% of cases, and in another 20% the potential was assessed as possible. The chance corrected agreements, however, were poor (k < 0.20) within and between groups of National Insurance collaborators. The agreement between National Insurance collaborators and the sick-listed subjects was no better than chance. Neither extended medical information nor formal medical competence increased agreement in cases where modified working conditions might have reduced sick leave.
Information in medical sickness certificates proved ineffective in detecting cases where modified working conditions may reduce sick leave, and focusing on medical certificates may prevent identification of needed interventions. Strategies on how to communicate directly with sick-listed subjects would enable social authorities to exploit more of the sick leave reduction potential by modifying the working conditions than strategies on improving medical information.
在审查旨在避免或减少病假对个人和社区产生的副作用的针对性干预策略的必要性时，医疗病假证明通常是主要信息来源。本研究探讨了挪威国家保险办公室中与日常工作相关的医疗病假证明对于识别病假人员的价值，在这些病假人员中，调整工作条件可能会减少持续的病假时间。
由四名挪威国家保险工作人员（两名有正式医学资质，两名没有）对999例连续病假案例的常规病假证明进行单独评估，以确定通过调整工作条件减少持续病假时间的可能性。该研究于1997年和1998年在挪威北部进行。判断时采用了与均值差异、kappa值以及评估者组内和组间的比例一致性分析来分析一致性。另外，在159例病假案例中分析了评估者与病假人员自我评估之间的一致性。
病假人员和国家保险工作人员都预计，在20% - 30%的案例中病假时间有可能减少，另有20%的案例被评估为有可能减少。然而，国家保险工作人员组内和组间的机会校正一致性较差（kappa < 0.20）。国家保险工作人员与病假人员之间的一致性并不比随机情况好。在调整工作条件可能减少病假的案例中，无论是扩展的医学信息还是正式的医学资质都没有提高一致性。
医疗病假证明中的信息在检测调整工作条件可能减少病假的案例方面被证明是无效的，专注于医疗证明可能会阻碍识别所需的干预措施。与病假人员直接沟通的策略比改善医学信息的策略更能使社会当局通过调整工作条件挖掘更多减少病假的潜力。
