Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar;40(1):104-114.
doi: 10.1080/02813432.2022.2036420. Epub 2022 Mar 7.

Interventions regarding physicians' sickness certification practice - a systematic literature review with meta-analyses

Söderman M  1 , Wennman-Larsen A  2   3 , Hoving J L  4 , Alexanderson K  2 , Friberg E  2
Affiliations
Meta-Analysis

Interventions regarding physicians' sickness certification practice - a systematic literature review with meta-analyses

Söderman M et al. Scand J Prim Health Care. 2022 Mar.

Abstract

Objective: A variety of interventions aiming to influence physicians' sickness certification practice have been conducted, most are, however, not evaluated scientifically. The aim of this systematic literature review was to obtain updated knowledge about interventions regarding physicians' sickness certification practice and to summarize their possible effects, in terms of sickness absence (SA) or return to work (RTW) among patients.

Methods: We searched PubMed and Web of Science up through 15 June 2020 and selected peer-reviewed studies that reported effects of controlled interventions that aimed to improve physicians' sickness certification practice and used SA or RTW among patients as outcome measures. Meta-analyses were conducted using random-effect models.

Results: Of the 1399 identified publications, 12 studies covering 9 interventions were assessed as relevant and included in the review. Most (70%) were from the Netherlands, two had a controlled, and seven a randomized controlled study design. All interventions included some type of training of physicians, and two interventions also included IT-support. Regarding the outcomes of SA/RTW, 30 different effect measures were used. In the meta-analyses, no statistically significant effect in favor of the interventions was observed for having any RTW (i.e. first, partial, or full) nor full RTW.

Conclusions: The individual studies showed that physicians' sickness certification practice might be influenced by interventions in both the intended and non-intended direction, however, no statistically significant effect was indicated by the meta-analysis. The included studies varied considerably concerning intervention content and effect measures.KEY POINTSThe knowledge is very limited regarding the content of interventions directed to physician's sickness certification practiceThe identified interventions included some type of training of physicians, and some of them also included IT-support for physiciansThere was a great heterogeneity among the interventions concerning effect measures used regarding return to work among patientsThe individual studies showed that physicians' sickness certification practice might be influenced by interventions in both intended and non-intended directions, however, the overall meta-analysis did not indicate an effect.

Keywords: CRD42019119697 (a revised protocol is under assessment after submission 4 September 2020; Sick leave; delay due to the covid-19 situation); insurance medicine; intervention; meta-analysis; physicians’ practice patterns; return to work; sickness certification; systematic review.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1. Flow chart showing selection of included studies.
Figure 1. Flow chart showing selection of included studies.
Figure 2.
Figure 2.
(a) Any return to work. (b) Full return to work.
See this image and copyright information in PMC

References

    1. OECD, Sickness, Disability and Work: Breaking the Barriers: A Synthesis of Findings across OECD Countries. 2010, OECD Publishing, Paris.
    1. Floderus B, Göransson S, Alexanderson K, et al. . Self-estimated life situation in patients on long-term sick leave. J Rehabil Med. 2005;37(5):291–299. - PubMed
    1. Mittendorfer-Rutz E, Kjeldgård L, Runeson B, et al. . Sickness absence due to specific mental diagnoses and all-cause and cause-specific mortality: a cohort study of 4.9 million inhabitants of Sweden. PLoS One. 2012;7(9):e45788. - PMC - PubMed
    1. Mather L, Blom V, Bergström G, et al. . Adverse outcomes of sick leave due to mental disorders: a prospective study of discordant twin pairs. Scand J Public Health. 2019;47(2):127–136. - PubMed
    1. Wang M, Alexanderson K, Runeson B, et al. . Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? A nationwide register-based cohort study of 4.9 million inhabitants of Sweden. Occup Environ Med. 2014;71(1):12–20. - PubMed