title: Quality of medical certificates issued in long-term sick leave or disability in relation to patient characteristics and delivery of health care.
abstract: OBJECTIVE
  To assess the quality of medical certificates issued during long-term sick leave or disability.
  
  
  METHODS
  We collected a stratified randomised sample of 250 medical certificates issued for assessment of work capacity: Certificates issued in primary health care (PHC) with a locomotor, psychiatric or other main diagnosis, in psychiatric care, and in other secondary care. Four experts performed a quality assessment per section of the certificate and globally.
  
  
  RESULTS
  The certificates varied from short notes to extensive documents. Those issued in PHC included more diagnoses per certificate (p < 0.0001) than in secondary care. PHC physicians had a longer professional relationship to their patients (p = 0.009). Information on work capacity was entirely adequate and relevant in only 10% of the certificates. Disturbed mental function was indicated in 60% of the certificates without psychiatric main diagnosis. Whether indicated medical state influenced functional state was not assessable in 46 (19 %) of the certificates due to lack of information. Similarly, if reduced function influenced working capacity was not assessable in 66 (27 %) of the certificates. The global quality differed (p < 0.0001) between certificates issued in primary care 5.7 (CI 5.5-5.9) and secondary care 6.9 (CI 6.5-7.3).
  
  
  CONCLUSIONS
  There is a need for improvement of the quality of medical certificates issued in cases of long-term sick leave or disability. The quality of medical certificates was low and lacked necessary information requested by the Social Insurance Agency. The quality was lower in certificates issued in primary care, which might be explained by a different case-mix.
authors: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. anna.kiessling@ki.se
authors: Anna
authors: A
authors: Kiessling
authors: Britt
authors: B
authors: Arrelöv
authors: Anny
authors: A
authors: Larsson
authors: Peter
authors: P
authors: Henriksson
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004608:Eligibility Determination / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D063127:Secondary Health Care; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden; D013997:Time Factors
keywords: Delivery of health care; primary health care; quality assessment; sick leave; work capacity evaluation