Sickness certification

This article forms part of our 'Paperwork' series for 2011, providing information about a range of paperwork that general practitioners complete regularly. The aim of the series is to provide information on the purpose of the paperwork, and hints on how to complete it accurately. This will allow the GP to be more efficient and the patient to have an accurately completed piece of paperwork for the purpose required. Sickness certificates are legal documents. Medical boards receive numerous complaints each year from patients, employers, insurers and other parties about the quality and accuracy of sickness certificates. General practitioners who deliberately issue a false, misleading or inaccurate certificate could face disciplinary action, or even a charge of fraud. This article provides some guidance for GPs about writing certificates certifying illness, and discusses common medicolegal issues associated with sickness certificates.     

Sickness certification in general practice: a review

Sickness certification is one of the most common tasks performed in general practice. This review describes and discusses concepts and terms used in earlier studies. 'Sickness certification' is defined, and related to the issues of 'absence from work' and 'sickness absence'. The use of measurements and results reported are emphasized according to patient- and doctor-related variables. Great variations are found, and some of the reasons may be differences in morbidity patterns, diagnostic procedures or sickness benefit acts. However, in studies from general practice, the number of sickness certificates is related to different denominators without describing the real population at risk, that is those of the patients who were employed or entitled to sickness benefits. Further studies are needed on the epidemiology of sickness certification, and the duration of the episodes. Analysis of the basis for the doctors' decisions, the patients' viewpoint, inter-doctor variations and doctors' attitudes should also be emphasized in the future. There is a need to discuss the reliability and validity of the measurements used, and theoretical considerations of the doctor's sickness certification practice are called for.     

Rates of sickness certification in European primary care: A systematic review

Background: General practitioners (GPs) are responsible for assessing a patient's capacity for work and issuing a sickness certificate, enabling a patient to receive statutory sick pay and take time away from the workplace. The management of sickness absence across Europe varies considerably, and there is a need for comparable rates of certification to facilitate appropriate health and economic planning. Objective: To systematically review the literature reporting rates of sickness certification in general practice settings. Methods: Electronic databases were searched from their inception to November 2007. Inclusion criteria were reporting a measure of sickness certification, conducted in European primary care. Results: 298 citations were identified from the literature search, of which 11 met the inclusion criteria. These studies demonstrated that the rates of sickness certification are not routinely recorded. The certified rates were subject to wide variation, ranging from 18 per 100 person years in Norway to 239 per 100 person years in Malta.

Conclusion: There is large variability in sickness certification policy and hence sickness certification rates across Europe. A system that enables comparisons across countries would be beneficial in ensuring health and economic planning. To enable a baseline rate of certification to be established and compared across countries, standardized reporting of sickness certification is needed.     

Supplier certification for health care

Supplier certification is an ongoing, formalized improvement process between a customer and a supplier. Ideally, suppliers and healthcare organizations will become extensions of one another, allowing for achievement of significant quality improvement over the long haul. There are six steps to implementing the process: 1) learning the process, 2) building a team, 3) defining objectives, 4) identifying evaluative criteria, 5) developing a measurement system and 6) selecting suppliers. For different levels of certification--defined by specific criteria--the customer receives more benefits and the supplier receives larger incentives.     

Sickness certification as a complex professional and collaborative activity - a qualitative study

ABSTRACT: BACKGROUND: Physicians have an important but problematic task to issue sickness certifications. A manifold of studies have identified a wide spectrum of medical and insurance-related problems in sickness certification. Despite educational efforts aiming to improve physicians' knowledge of social insurance medicine there are no signs of reduction of these problems. We hypothesised that the quality deficits is not only due to lack of knowledge among issuing physicians. The aim of the study was to explore physicians' challenges when handling sickness certification in relation to their professional roles as physicians and to their interaction with different stakeholders. METHODS: One hundred seventy-seven physicians in Stockholm County, Sweden, participated in a sick-listing audit program. Participants identified challenges in handling sick-leave issues and formulated action plans for improvement. Challenges and responsible stakeholders were identified in the action plans. To deepen the understanding facilitators of the program were interviewed. A qualitative content analysis was performed exploring challenge categories and categories of stakeholders with responsibility to initiate actions to improve the quality of the sick-listing process. The challenge categories were then related by their content to professional competence roles in accord with the Canadian Medical Education Directions for Specialists (CanMEDS) framework and to the stakeholder categories. RESULTS: Seven categories of challenges were identified. Practitioner patient interaction, Work capacity assessment, Interaction with the Social Insurance Administration, The patient's workplace and the labour market, Sick-listing practice, Collaboration and resource allocation within the Health Care System, Leadership and routines at the Health Care Unit. The challenges were related to all seven CanMEDS roles. Five categories of stakeholders were identified and several stakeholders were involved in each challenge category. CONCLUSIONS: Physicians performing sickness certification tasks experience a complex variety of challenges. From physician perspective actions to handle these need to be initiated in interaction with both medical and non-medical stakeholders. The relation between the challenges and a well-established professional competence framework revealed a complex pattern. Thus, from a public health perspective, educational activities aimed to improve the sick-listing process should address all physician competences including identification and interaction with stakeholders, and not just knowledge of social insurance medicine.     

Sickness certification in the general practice consultation: the patients' perspective, a qualitative study

BACKGROUND: Up to a third of general practice consultations involve issuing sickness certificates. Recent research has looked at the GPs' perspective of sickness certification but there has been no in-depth research exploring patients' views of these consultations. AIM: To explore patients' views of sickness certification within general practice consultations, and how these could be improved. METHODS: A qualitative study was carried out with 12 general practices in South Wales; interview study of 19 patients who had recently received a sick note from a GP. Results: Patients rarely attended just for a sick note, more often wanting advice or an opportunity to ask questions. Patients valued continuity of care, a good doctor-patient relationship, adequate consultation time and discussion about their illness, social situation and work-related issues when consulting with their GP for a sick note. Many patients felt doctors did not have enough time or knowledge of the patient to the able to address this issue adequately and this increased feelings of anxiety. Patients did not feel that being questioned by their GP or discussing return to work threatened the doctor-patient relationship. CONCLUSIONS: GPs who simply give out sick notes without question or discussion are not necessarily giving the patient what they want. More time should be spent discussing work and illness-related issues. Policy makers should recognize that continuity of care a good doctor-patient relationship and adequate consultation time are important to patients and any initiatives aimed at GPs to improve return to work rates should take these into consideration.     

Union certification elections in nursing care facilities

This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.     

A pilot program to improve causes of death certification in primary care of Catalonia, Spain

OBJECTIVE: The BEDTAR pilot program assessed changes in the quality of certification of death's causes after a training session for the primary care physicians in the Tarragona's Area of Catalonia, in the Northeast of the Iberian Peninsula. DESIGN: Before-after evaluative study with intervention and without control group. SETTING AND PARTICIPANTS: The study population was the physicians of the reformed primary health care network of the AT. MATERIAL AND METHODS: The training session began with a test consisting of certifying 3 deaths. This test was followed by a theoretical and practical seminar. The session concluded with a final test consisting on certifying the same 3 cases. The variables used to evaluate the quality the certification were: logical sequence the death causes, correct position on death certificate of the immediate, intermediate and basic causes, precise use of cardiac arrest and other ill-defined diseases, appropriate use of abbreviations, legibility, vocabulary and, finally, use of all the available information. RESULTS: The final participation of the study population was 71% and the global program efficacy was 59%. CONCLUSIONS: The BEDTAR program improved the quality of certification and emphasized the relevancy and the applicability of the results.     

Supplier certification modified for health care

There have been numerous articles written in detail regarding industrial-based supplier certification programs. These programs generally concentrate on suppliers of raw materials. After reviewing them, it is difficult to visualize how these programs could support the ambulatory or inpatient operations of a healthcare institution. The University of Maryland Medical Center, a 747-bed teaching hospital in Baltimore, took on the challenge to adapt the supplier certification program to support its healthcare institution. After months of struggle, a program emerged by expanding the Medical Center's current process management philosophy, to include its suppliers. Documentation from the program developed by the Medical Center indicates the level of supplier support has increased. Through this certification program, the supplier is aware of the Medical Center's expectations and needs. In turn, the Medical Center has become aware of how its internal processes can hinder the supplier's operation. The supplier certification program has provided a valuable communication conduit. This article covers a brief summation of the industrial-based supplier certification program and how the University of Maryland Medical Center has adapted the program to support all its operations.