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Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries.
BMJ Open. 2016 07 14; 6(7):e011316.BO

Abstract

OBJECTIVES

A comparison of appraisals made by general practitioners (GPs) in France and occupational physicians (OPs) and insurance physicians (IPs) in the Netherlands with those made by Scandinavian GPs on work capacity in patients with severe subjective health complaints (SHCs).

SETTING

GPs in France and OPs/IPs in the Netherlands gathered to watch nine authentic video recordings from a Norwegian general practice.

PARTICIPANTS

46 GPs in France and 93 OPs/IPs in the Netherlands were invited to a 1-day course on SHC.

OUTCOMES

Recommendation of sick leave (full or partial) or no sick leave for each of the patients.

RESULTS

Compared with Norwegian GPs, sick leave was less likely to be granted by Swedish GPs (OR 0.51, 95% CI 0.30 to 0.86) and by Dutch OPs/IPs (OR 0.53, 95% CI 0.37 to 0.78). The differences between Swedish and Norwegian GPs were maintained in the adjusted analyses (OR 0.43, 95% CI 0.23 to 0.79). This was also true for the differences between Dutch and Norwegian physicians (OR 0.55, 95% CI 0.36 to 0.86). Overall, compared with the GPs, the Dutch OPs/IPs were less likely to grant sick leave (OR 0.60, 95% CI 0.45 to 0.87).

CONCLUSIONS

Swedish GPs and Dutch OPs/IPs were less likely to grant sick leave to patients with severe SHC compared with GPs from Norway, while GPs from Denmark and France were just as likely to grant sick leave as the Norwegian GPs. We suggest that these findings may be due to the guidelines on sick-listing and on patients with severe SHC which exist in Sweden and the Netherlands, respectively. Differences in the working conditions, relationships with patients and training of specialists in occupational medicine may also have affected the results. However, a pattern was observed in which of the patients the physicians in all countries thought should be sick-listed, suggesting that the physicians share tacit knowledge regarding sick leave decision-making in patients with severe SHC.

Authors+Show Affiliations

Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway Research Unit for General Practice, Uni Research Health, Bergen, Norway.Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Uni Research Health, Bergen, Norway.Uni Research Health, Bergen, Norway Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands Department of Social Medical Affairs, UWV, Dutch Social Security Agency, Amsterdam, The Netherlands.Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France.Department of Public and Occupational Health, the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27417198

Citation

Werner, Erik L., et al. "Physicians' Assessments of Work Capacity in Patients With Severe Subjective Health Complaints: a Cross-sectional Study On Differences Between Five European Countries." BMJ Open, vol. 6, no. 7, 2016, pp. e011316.
Werner EL, Merkus SL, Mæland S, et al. Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries. BMJ Open. 2016;6(7):e011316.
Werner, E. L., Merkus, S. L., Mæland, S., Jourdain, M., Schaafsma, F., Canevet, J. P., Weerdesteijn, K. H., Rat, C., & Anema, J. R. (2016). Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries. BMJ Open, 6(7), e011316. https://doi.org/10.1136/bmjopen-2016-011316
Werner EL, et al. Physicians' Assessments of Work Capacity in Patients With Severe Subjective Health Complaints: a Cross-sectional Study On Differences Between Five European Countries. BMJ Open. 2016 07 14;6(7):e011316. PubMed PMID: 27417198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physicians' assessments of work capacity in patients with severe subjective health complaints: a cross-sectional study on differences between five European countries. AU - Werner,Erik L, AU - Merkus,Suzanne L, AU - Mæland,Silje, AU - Jourdain,Maud, AU - Schaafsma,Frederieke, AU - Canevet,Jean Paul, AU - Weerdesteijn,Kristel H N, AU - Rat,Cédric, AU - Anema,Johannes R, Y1 - 2016/07/14/ PY - 2016/7/16/entrez PY - 2016/7/16/pubmed PY - 2017/12/12/medline KW - GENERAL MEDICINE (see Internal Medicine) KW - HEALTH SERVICES ADMINISTRATION & MANAGEMENT KW - OCCUPATIONAL & INDUSTRIAL MEDICINE KW - PAIN MANAGEMENT KW - PRIMARY CARE KW - PUBLIC HEALTH SP - e011316 EP - e011316 JF - BMJ open JO - BMJ Open VL - 6 IS - 7 N2 - OBJECTIVES: A comparison of appraisals made by general practitioners (GPs) in France and occupational physicians (OPs) and insurance physicians (IPs) in the Netherlands with those made by Scandinavian GPs on work capacity in patients with severe subjective health complaints (SHCs). SETTING: GPs in France and OPs/IPs in the Netherlands gathered to watch nine authentic video recordings from a Norwegian general practice. PARTICIPANTS: 46 GPs in France and 93 OPs/IPs in the Netherlands were invited to a 1-day course on SHC. OUTCOMES: Recommendation of sick leave (full or partial) or no sick leave for each of the patients. RESULTS: Compared with Norwegian GPs, sick leave was less likely to be granted by Swedish GPs (OR 0.51, 95% CI 0.30 to 0.86) and by Dutch OPs/IPs (OR 0.53, 95% CI 0.37 to 0.78). The differences between Swedish and Norwegian GPs were maintained in the adjusted analyses (OR 0.43, 95% CI 0.23 to 0.79). This was also true for the differences between Dutch and Norwegian physicians (OR 0.55, 95% CI 0.36 to 0.86). Overall, compared with the GPs, the Dutch OPs/IPs were less likely to grant sick leave (OR 0.60, 95% CI 0.45 to 0.87). CONCLUSIONS: Swedish GPs and Dutch OPs/IPs were less likely to grant sick leave to patients with severe SHC compared with GPs from Norway, while GPs from Denmark and France were just as likely to grant sick leave as the Norwegian GPs. We suggest that these findings may be due to the guidelines on sick-listing and on patients with severe SHC which exist in Sweden and the Netherlands, respectively. Differences in the working conditions, relationships with patients and training of specialists in occupational medicine may also have affected the results. However, a pattern was observed in which of the patients the physicians in all countries thought should be sick-listed, suggesting that the physicians share tacit knowledge regarding sick leave decision-making in patients with severe SHC. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/27417198/Physicians'_assessments_of_work_capacity_in_patients_with_severe_subjective_health_complaints:_a_cross_sectional_study_on_differences_between_five_European_countries_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=27417198 DB - PRIME DP - Unbound Medicine ER -