title: Difficulties with the sickness certification process in general practice and possible solutions: a systematic review.
abstract: BACKGROUND
  Prescription of sick leave periods is a common but complex task in general practice in many countries.
  
  
  OBJECTIVE
  The objective was to identify issues around sickness certification and solutions aimed at improving this process.
  
  
  METHODS
  Through Medline, Cochrane, and Web of Science bibliographic databases, 56 relevant original articles in English or French were retrieved, focusing on the certification process in general practice. Data was synthesized using a thematic analysis.
  
  
  RESULTS
  The various issues identified were difficulties in assessing the need for sick leave and its length, difficulties in the doctor-patient relationship, and difficulties related to healthcare system organization and to the socioeconomic environment. Some possible solutions to these difficulties have been assessed either for validity or effectiveness. In particular, patient functional assessment or cooperation with occupational practitioners could help in adjusting the sick periods. Guidelines or legislative reforms on sickness certification could only potentially improve the filling in of certificates.
  
  
  CONCLUSIONS
  Sickness certification represents a procedural as well as a relational, organizational and political challenge. Well-validated tools or procedures to support doctors in this task are lacking. The development of functional assessment and cooperation with occupational practitioners requires appropriate training and education for present and future GPs. Further research is needed to refine these strategies, which should be tailored to each country.
authors.affiliation: Department of General Practice, University of Lyon 1, France. laurent.letrilliart@wanadoo.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Letrilliart
authors.forename: Anne
authors.initials: A
authors.lastname: Barrau
mesh_terms: D002568:Certification / Q000592:standards*; D003430:Cross-Sectional Studies; D058006:General Practice; D006801:Humans; D018582:Sick Leave; D014938:Work Capacity Evaluation