Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
R&D Centre Skaraborg Primary Care , Skövde , Sweden.
Scand J Prim Health Care. 2019 Sep;37(3):319-326. doi: 10.1080/02813432.2019.1639905. Epub 2019 Aug 13.
To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses. Retrospective case control study 2013-2014. Primary health care, Sweden. . Patients with new onset sickness certificates with symptom diagnoses = 222, and disease specific diagnoses (controls), = 222. Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans. Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, = 0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days = 0.018) and more certificates issued by telephone (23% vs. 15% = 0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, < 0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, < 0.001), but less follow-up (16% vs. 26%, < 0.008). In both groups contacts related to rehabilitation and with employers were scarce. Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing. KEY POINTS Symptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses. Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses. Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.
比较症状诊断和特定疾病诊断的患者病假条和康复活动信息。2013-2014 年回顾性病例对照研究。初级保健，瑞典。新出现症状诊断的病假条患者 = 222 例，特定疾病诊断（对照组） = 222 例。主要评估参数：证书中身体功能和活动受限信息、病假天数、电话续假、诊断性检查、医疗保健利用、患者间、康复协调员、社会保险官员、雇主之间的联系以及康复计划的发生。根据指南，所有证书中约有一半的身体功能和活动受限信息是充足的，但症状诊断患者的信息不如对照组（44%比 56%， = 0.008）。症状诊断患者的病假时间比对照组短（116 比 151 天 = 0.018），电话续假的比例更高（23%比 15%， = 0.038）。此外，他们接受了更多的诊断性检查（32%比 18%， < 0.001），在病假前一年，他们更多地去看医生（82%比 68%， < 0.001），但随访较少（16%比 26%， < 0.008）。在这两组中，与康复和雇主有关的联系都很少。与特定疾病诊断相比，症状诊断的病假条可作为证明质量不足和医疗保健利用率较高的患者的标志物。总的来说，一半的病假条信息不足，实践中早期与雇主和康复活动的联系缺失。关键点症状诊断被提议作为病假条质量的标志物。我们通过比较有和没有症状诊断的病假条来研究这一点。与特定疾病诊断相比，症状诊断的病假条在信息方面存在更高的缺失度。无论诊断如何，患者、康复协调员和社会保险官员之间的早期联系都很少，与雇主的联系也不存在。
