Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, S-171 77 Stockholm, Sweden.
BMC Public Health. 2010 Feb 9;10:61. doi: 10.1186/1471-2458-10-61.
Sickness absence is a problem in many Western countries. Physicians have an essential role in sickness certification of patients, which is often recommended in health care but may have side effects. Despite the potentially harming impact of sickness absence, physicians have very limited training in insurance medicine, and there is little research on sickness certification practices. Our aim was to ascertain what knowledge and skills physicians in different clinical settings feel they need in order to improve their competence in sickness certification.
The data for analysis were collected in 2004 in Stockholm and Ostergötland Counties, Sweden, by use of a comprehensive questionnaire about sickness certification issues, which was sent to 7,665 physicians aged <or= 64 years. The response rate was 71% (n = 5455). Analyses of association and factor analysis were applied to the various aspects of competence to establish a skills index and a knowledge index, which were used to compare the results for physicians in different clinical settings.
Most physicians stated they needed more knowledge and skills in handling sickness certification, e.g. regarding how to assess work capacity (44%) and optimal length and degree of sickness absence (50%), and information about aspects of the social insurance system (43-63%). Few (20%) reported needing to know more about issuing sickness certificates. The index scores varied substantially between different clinical settings, and this disparity remained after adjustment for sex, years in practice, workplace policy, and support from management. Scores on the skills index were significantly higher for physicians in primary care than for those working in other areas.
A majority of physicians in most types of clinics/practices, not only primary care, indicated the need for more knowledge and skills in handling sickness certification cases. Increased knowledge and skills are needed in order to protect both the health and equity of patients. However, few physicians stated that they needed more skills in filling out sickness certificates, which contradicts previous findings about such documents being of poor quality and suggests that factors other than mere knowledge and skills are involved.
在许多西方国家，病假都是一个问题。医生在为患者开具病假证明方面发挥着重要作用，这在医疗保健中经常被推荐，但可能会产生副作用。尽管病假可能会带来潜在的危害，但医生在保险医学方面的培训非常有限，关于病假证明实践的研究也很少。我们的目的是确定不同临床环境中的医生认为他们需要哪些知识和技能，以提高他们在病假证明方面的能力。
2004 年，在瑞典斯德哥尔摩和东约特兰郡，我们使用了一份关于病假证明问题的综合问卷，对 7665 名年龄<64 岁的医生进行了调查。回复率为 71%（n=5455）。我们对各种能力方面进行了关联分析和因子分析，以建立技能指数和知识指数，并用这些指数来比较不同临床环境中的医生的结果。
大多数医生表示，他们在处理病假证明方面需要更多的知识和技能，例如如何评估工作能力（44%）和病假的最佳长度和程度（50%），以及有关社会保险制度方面的信息（43-63%）。很少（20%）的医生表示需要更多了解开具病假证明的相关知识。不同临床环境之间的指数得分差异很大，在调整了性别、行医年限、工作场所政策和管理层支持后，这种差异仍然存在。在初级保健医生中，技能指数得分明显高于其他领域的医生。
大多数类型的诊所/实践中的医生，不仅是初级保健医生，都表示需要更多的知识和技能来处理病假证明。为了保护患者的健康和公平，需要增加知识和技能。然而，很少有医生表示他们需要更多填写病假证明的技能，这与之前关于此类文件质量较差的发现相矛盾，这表明除了知识和技能之外，还有其他因素在起作用。
