Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
BMC Fam Pract. 2012 Mar 1;13:10. doi: 10.1186/1471-2296-13-10.
In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic.
Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding.
Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave.
The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.
在大多数拥有医疗保险制度的国家，全科医生（GP）在病假流程中发挥着关键作用。既往研究表明，GP 在与病假证明咨询相关的多项任务和情况下存在问题。不同国家的初级卫生保健和社会保险系统组织的差异可能会影响 GP 的经历和证明。本研究旨在通过比较瑞典和挪威的数据，进一步了解 GP 在病假证明方面的经历，包括发现有问题的证明频率和方面。
对瑞典和挪威 GP 进行横断面调查数据的统计分析。在瑞典，所有 GP 均被纳入研究，其中 3949 名（60.6%）做出回应。在挪威，代表性的 GP 样本被纳入研究，其中 221 名（66.5%）做出回应。
大多数 GP 报告每周至少进行一次涉及病假证明的咨询；瑞典的 95%和挪威的 99%的 GP 都这样做。大多数 GP 认为这些任务存在问题；瑞典的 60%和挪威的 53%的 GP 都这样认为。在逻辑回归中，瑞典和挪威的 GP 都发现，病假证明咨询的频率越高，他们认为这些咨询有问题的风险就越高。与挪威相比，瑞典有更多的 GP 报告遇到过没有医学理由而要求病假证明的患者。瑞典的 GP 发现与患者讨论病假的利弊以及延长另一位医生开具的病假期限更为困难。挪威的 GP 更担心如果他们不开具证书，患者会去找另一位医生，并且有更高比例的挪威 GP 发现处理他们和他们的患者在病假需求上存在分歧的情况存在问题。
本研究证实，许多 GP 认为病假咨询存在问题。然而，两国 GP 的经历存在差异，这可能与社会保险法规和 GP 服务组织的差异有关。未来的研究应关注国家差异的可能原因和后果。
