Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Scand J Public Health. 2013 Jun;41(4):412-20. doi: 10.1177/1403494813477928. Epub 2013 Feb 21.
To assess the quality of medical certificates issued during long-term sick leave or disability.
We collected a stratified randomised sample of 250 medical certificates issued for assessment of work capacity: Certificates issued in primary health care (PHC) with a locomotor, psychiatric or other main diagnosis, in psychiatric care, and in other secondary care. Four experts performed a quality assessment per section of the certificate and globally.
The certificates varied from short notes to extensive documents. Those issued in PHC included more diagnoses per certificate (p < 0.0001) than in secondary care. PHC physicians had a longer professional relationship to their patients (p = 0.009). Information on work capacity was entirely adequate and relevant in only 10% of the certificates. Disturbed mental function was indicated in 60% of the certificates without psychiatric main diagnosis. Whether indicated medical state influenced functional state was not assessable in 46 (19 %) of the certificates due to lack of information. Similarly, if reduced function influenced working capacity was not assessable in 66 (27 %) of the certificates. The global quality differed (p < 0.0001) between certificates issued in primary care 5.7 (CI 5.5-5.9) and secondary care 6.9 (CI 6.5-7.3).
There is a need for improvement of the quality of medical certificates issued in cases of long-term sick leave or disability. The quality of medical certificates was low and lacked necessary information requested by the Social Insurance Agency. The quality was lower in certificates issued in primary care, which might be explained by a different case-mix.
评估长期病假或残疾期间出具的医疗证明的质量。
我们收集了 250 份评估工作能力的医疗证明的分层随机样本：在初级保健 (PHC) 中因运动、精神或其他主要诊断、在精神保健中以及在其他二级保健中开具的医疗证明。四位专家对每份证书的各个部分以及整体进行质量评估。
这些证书的形式从简短的说明到详细的文件不等。在 PHC 中开具的证书每份证书包含更多的诊断（p<0.0001），而在二级保健中开具的证书则较少。PHC 医生与他们的患者之间的专业关系更长（p=0.009）。仅在 10%的证书中，关于工作能力的信息是完全充分且相关的。在没有精神科主要诊断的情况下，60%的证书表明精神功能障碍。由于缺乏信息，无法评估表明的医疗状况是否影响功能状态，在 46 份（19%）证书中是这样。同样，由于缺乏信息，在 66 份（27%）证书中也无法评估功能下降是否影响工作能力。由于信息不足，社会保险公司要求的质量差异（p<0.0001），初级保健中开具的证书为 5.7（CI 5.5-5.9），二级保健中开具的证书为 6.9（CI 6.5-7.3）。
需要改进长期病假或残疾期间出具的医疗证明的质量。医疗证明的质量较低，缺乏社会保险公司要求的必要信息。在初级保健中开具的证书质量较低，这可能是由于病例组合不同所致。
