Shiels Chris, Gabbay Mark, Hillage Jim
Department of Health Services Research, University of Liverpool, Liverpool.
Br J Gen Pract. 2014 Mar;64(620):e137-43. doi: 10.3399/bjgp14X677509.
The 'fit note', with the opportunity for the GP to advise that a patient 'may be fit' to do some work, was introduced in April 2010.
To estimate numbers of fit notes with 'may be fit' advice, the types of advice, and factors associated with any inclusion of such advice in the fit note.
Cross-sectional analysis of fit note data from 68 general practices in eight regions of England, Wales and Scotland.
Collection of practice fit note data via GP use of carbonised pads of fit notes for a period of 12 months.
The 'may be fit' box was ticked on 5080 fit notes (6.4% of all fit notes in study). But there was a wide variation in completion rates across the 68 practices (from 1% to 15%). The most prevalent individual item of advice was to 'amend duties' of patient as a prerequisite for return to work (included in 42% of all notes containing any 'may be fit' advice). Advice was often incomplete or irrelevant, with some GPs failing to comply with official guidance. Inclusion of any 'may be fit' advice was independently associated with the patient being female, less socially deprived and having a physical health reason for receiving a fit note.
Unlike other studies that have relied upon eliciting opinion, this study investigates how the fit note is being used in practice. Findings provide some evidence that the fit note is not yet being used to the optimum benefit of patients (and their employers).
“适合工作证明”于2010年4月推出，全科医生有机会建议患者“可能适合”从事某些工作。
估计包含“可能适合”建议的适合工作证明数量、建议类型以及与适合工作证明中包含此类建议相关的因素。
对来自英格兰、威尔士和苏格兰八个地区68家全科诊所的适合工作证明数据进行横断面分析。
通过全科医生使用复写式适合工作证明收集诊所12个月期间的适合工作证明数据。
在5080份适合工作证明上勾选了“可能适合”选项（占研究中所有适合工作证明的6.4%）。但68家诊所的完成率差异很大（从1%到15%）。最常见的单项建议是将患者的“工作职责调整”作为重返工作岗位的前提条件（在所有包含任何“可能适合”建议的证明中占42%）。建议往往不完整或不相关，一些全科医生未遵守官方指南。包含任何“可能适合”建议与患者为女性、社会剥夺程度较低以及因身体健康原因获得适合工作证明独立相关。
与其他依赖征求意见的研究不同，本研究调查了适合工作证明在实际中的使用情况。研究结果提供了一些证据，表明适合工作证明尚未被用于使患者（及其雇主）获得最大利益。
