Physician’s use of sickness certification guidelines: a nationwide survey of 13 750 physicians in different types of clinics in Sweden

OBJECTIVES: To explore physicians’ experiences of using the national sickness certification guidelines introduced in 2007 and the types of information they used, in general and in different types of clinics. DESIGN: Cross-sectional survey. SETTING: Most physicians working in Sweden in 2017. PARTICIPANTS: A questionnaire was sent to 34 718 physicians; 54% responded. Analyses were based on answers from the 13 750 physicians who had sick leave cases. OUTCOME MEASURES: To what extent the guidelines were used and what type of information from them that was used. RESULTS: Ten years after the sickness certification guidelines were introduced in Sweden, half of the physicians used them at least once a month. About 40% of physicians in primary healthcare and occupational health services used the guidelines every week. The type of information used varied; 53% used recommendations about duration and 29% about degree of sick leave. Using information about function and activity/work capacity, respectively, was more common within primary healthcare (37% and 38%), psychiatry (42% and 42%), and occupational health services (35% and 41%), and less common in surgery and orthopaedic clinics (12% and 12%) who more often used information about duration (48% and 53%). Moreover, 10% stated that the guidelines were very, and 24% fairly problematic to apply. Half (47%) stated that the guidelines facilitated their contacts with patients and 29% that they improved quality in their management of sick leave cases. More non-specialists, compared with specialists, found that the guidelines facilitated contacts with patients (OR 3.28, 95% CI 3.04 to 3.55). CONCLUSIONS: The majority of the physicians used the sickness certification guidelines, although this varied with type of clinic. Half stated that the guidelines facilitated patient contacts. Yet, some found it problematic to apply the guidelines. Further development of the guidelines is warranted as well as more knowledge about them among physicians.