Background Reports of work absence usually come from self-report or company absence records; however, these records are limited to just one company. Electronic recording of sickness certification in ...primary care medical records may provide an alternative source of data, but its relation to other sources of sickness absence information is unknown. Comparing general practitioner electronic sickness certification records with self-reported work absence would enable the comparability of these electronic records to be established. Aim To investigate the comparability of electronic medical records of sickness certification in primary care, with self-reported work absence. Methods Analysis included 292 primary care low-back pain consulters who consented to medical record review. A within-group design was used to match electronic records of sickness certification with self-reported sickness absence. Findings Overall 95% of the electronic medical records of sickness certification matched with self-reported absences; 96% in employed consulters and 95% in unemployed consulters. In all, 94% of employed participants were a direct match, 2% a consistent match and 4% a mismatch. Including consistent matches increased matching to 97% in employed consulters and to 100% in unemployed consulters. Electronic records of sickness certification in general practice are a useful method of analysing sickness absence in the population, as they are comparable with other sources of data. Additionally, electronic records of sickness certification will allow the investigation of sickness absence where data from one company are too limited and self-report is not available or unreliable. To facilitate the use of electronic medical records of sickness certification, data need to be accurately recorded and evaluated or audited to ensure completeness and validity. Furthermore, methods should be developed to ensure straightforward linkage between sickness certification records and other data held on the electronic medical record.
Widespread pain is a common condition, affecting approximately 16% of tine population at any one time. This pain impacts on all aspects of daily life, and approximately 80% of those with widespread ...pain experience chronic symptoms. Patients often attribute the onset of symptoms to a precipitating physical trauma - for example involvement in a road traffic accident - although there is little robust epidemiological evidence to support this. Previous studies have been cross sectional or case control in design and therefore subject to a number of methodological limitations: firstly, the potential of recall bias; and secondly, the inability to examine the onset of symptoms. The broad aims of this thesis are to determine, prospectively, whether trauma is associated with an increased risk of new onset widespread pain, and to identify in those experiencing trauma, which factors, measured at baseline, predict new onset widespread pain. Conclusions: Trauma, as exemplified by a road traffic accident, is associated with a modest increase in risk of new widespread pain. Prior accident health behaviours and post accident physical symptoms appear to be better predictors of widespread pain than accident specific factors. This thesis enables an "at risk" group to be identified, and hence, may assist in the targeting of both management and treatment in a group who would otherwise experience persistent symptoms. (Abstract shortened by ProQuest.)
The study aimed to explore the views of general practitioners (GPs), nurses and physiotherapists towards extending the role of sickness certification beyond the medical profession in primary care.
...Fifteen GPs, seven nurses and six physiotherapists were selected to achieve varied respondent characteristics including sex, geographical location, service duration and post-graduate specialist training. Constant-comparative qualitative analysis of data from 28 semi-structured telephone interviews was undertaken.
The majority of respondents supported the extended role concept; however members of each professional group also rejected the notion. Respondents employed four different legitimacy claims to justify their views and define their occupational boundaries in relation to sickness certification practice. Condition-specific legitimacy, the ability to adopt a holistic approach to sickness certification, system efficiency and control-related arguments were used to different degrees by each occupation. Practical suggestions for the extension of the sickness certification role beyond the medical profession are underpinned by the sociological theory of professional identity.
Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles. There is also a need to consider the impact on, and preferences of, the specific occupations and their respective boundary claims. This paper explores the implications of extending the sick certification role beyond general practice. We conclude that the main policy challenge of such a move is to a) persuade GPs to relinquish this role (or to share it with other professions), and b) to understand the 'boundary work' involved.
PDF
