Lindholm Christina, von Knorring Mia, Arrelöv Britt, Nilsson Gunnar, Hinas Elin, Alexanderson Kristina
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
BMC Res Notes. 2013 May 23;6:207. doi: 10.1186/1756-0500-6-207.
Health care in general and physicians in particular, play an important role in patients' sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification.
A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty.
The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support.
Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks.
总体而言，医疗保健尤其是医生，在患者疾病证明过程中发挥着重要作用。然而，瑞典已发现医疗保健领域在疾病证明如何实施方面缺乏管理。政府和郡议会引入了各种提高疾病证明质量的干预措施。其中一些措施专门旨在加强疾病证明的医疗保健管理；例如政策制定和管理支持。目的是描述不同医学专业的医生在其临床环境中在多大程度上能够获取关于疾病证明的联合政策，以及在进行疾病证明时体验到管理支持。
一项描述性研究，基于向斯德哥尔摩郡所有医生发送的两份横断面调查问卷的数据，内容涉及他们的疾病证明实践。纳入本研究的标准是在临床环境中工作、为获得委员会认证的专科医生、年龄<65岁，且每年至少进行几次疾病证明咨询。2004年有2497名医生、2008年有2204名医生符合这些标准。计算了获取政策和管理支持的比例，并根据医学专业进行分层。
2004年和2008年，在有完善疾病证明政策的临床环境中工作的医生比例总体较低，但不同类型医学专业之间差异很大（从6.1%到46.9%）。此外，不同医学专业在获得关于疾病证明的大量管理支持方面的报告差异也很大（从10.5%到48.8%）。超过三分之一的医生报告没有这种管理支持。
大多数医生并非在有完善疾病证明任务政策的临床环境中工作，他们也没有从其管理者那里获得大量支持。结果表明需要加强疾病证明任务的医疗保健管理，以便在这些任务中更好地支持医生。
