Bollag Ueli, Rajeswaran Anand, Ruffieux Christiane, Burnand Bernard
Swiss Sentinel Surveillance Network (SSSN), University of Bern, Bern, Switzerland.
Swiss Med Wkly. 2007 Jun 16;137(23-24):341-6. doi: 10.4414/smw.2007.11865.
Sickness certification is a routine task of primary care (PC) physicians which has an impact on patients' health, the health care system and the economy. As sickness certification is poorly studied, we quantified sickness certification and explored qualitatively the sickness certification process by Swiss PC physicians.
PC physicians participating in the Swiss Sentinel Surveillance Network (SSSN) recorded the frequency and duration of absence from work of each related consultation and certificate during 2005. Patients' age and gender, reason for sick leave, psychosocial cofactors, problems at the workplace, type of employment, type of occupation, duration of absence (weeks) and type of certificate were registered. Physicians' views on the procedure and their suggestions for change were gathered before and after the study by means of a questionnaire containing four open-ended questions.
Of the 223 SSSN physicians 73% participated. A total of 24,676 forms issued by 150 physicians were analysed. An average of four certificates was issued per 100 consultations; somewhat fewer by internists than by general practitioners and less in rural areas than urban areas. Psychosocial or work-related factors were mentioned in 20% of the certificates and were more often associated with longer absences from work. These factors were seen as inseparable from the somatic factors. Recommendations for change included the prolongation of self declaration time, a uniform declaration form, availability of an authority to which complex cases can be referred and the use of case management models.
Sickness certificates were issued in 4% of GP consultations. This task has been assessed by physicians as part of their function. The certification process should be improved through better coordination and communication between all parties involved: patients, employers, insurers, physicians and politicians.
疾病证明是基层医疗（PC）医生的一项日常工作，对患者健康、医疗系统和经济都有影响。由于对疾病证明的研究较少，我们对瑞士基层医疗医生出具疾病证明的情况进行了量化，并对疾病证明过程进行了定性探索。
参与瑞士哨点监测网络（SSSN）的基层医疗医生记录了2005年每次相关会诊和证明的缺勤频率及时长。登记了患者的年龄和性别、病假原因、心理社会辅助因素、工作场所问题、就业类型、职业类型、缺勤时长（周）以及证明类型。通过一份包含四个开放式问题的问卷，在研究前后收集了医生对该程序的看法及其改进建议。
223名SSSN医生中有73%参与了研究。共分析了150名医生出具的24,676份表格。每100次会诊平均出具4份证明；内科医生出具的证明比全科医生略少，农村地区比城市地区少。20%的证明中提到了心理社会或与工作相关的因素，且这些因素更常与较长的缺勤时间相关。这些因素被视为与躯体因素不可分割。改进建议包括延长自我申报时间、统一申报表格、设立可转诊复杂病例的机构以及采用病例管理模式。
4%的全科医生会诊出具了疾病证明。这项工作已被医生视为其职责的一部分。应通过改善患者、雇主、保险公司、医生和政界人士等所有相关方之间的协调与沟通来改进证明过程。
