Article Text

Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden
  1. Ylva Skånér1,2,
  2. Gunnar H Nilsson1,
  3. Britt Arrelöv2,
  4. Christina Lindholm2,
  5. Elin Hinas2,
  6. Anna Löfgren Wilteus2,
  7. Kristina Alexanderson2
  1. 1Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
  2. 2Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Ylva Skånér; ylva.skaner{at}


Objectives Diagnoses-specific sickness certification guidelines were recently introduced in Sweden. The aim of this study was to investigate to which extent general practitioners (GPs) used these guidelines and how useful they found them, 1 year after introduction.

Design A cross-sectional questionnaire study. A comprehensive questionnaire about sickness certification practices in 2008 was sent to all physicians living and working in Sweden (n=36 898, response rate 60.6%). In all, 19.7% (n=4394) of the responders worked as GPs.

Setting Primary healthcare in all Sweden.

Participants The participating GPs who had consultations concerning sickness certification at least a few times a year (n=4278, 97%).

Main outcome measures Descriptive statistics and prevalence ratios for the 11 questionnaire items about the use and usefulness of the sickness certification guidelines.

Results A majority (76.2%) of the GPs reported that they used the guidelines. In addition, 65.4% and 43.5% of those GPs reported that the guidelines had facilitated their contacts with patients and social insurance officers, respectively. The guidelines also helped nearly one-third (31.5%) of the GPs to develop their competence and improve the quality of their management of sickness certification consultations (33.5%). About half experienced some problems when using the guidelines and 43.7% wanted better competence in using them. A larger proportion of non-specialists and of GPs with fewer sickness certification consultations had benefitted from the guidelines.

Conclusions The national sickness certification guidelines implemented in Sweden were widely used by GPs already a year after introduction. Also, the GPs consider the guidelines useful in several respects, for example, in patient contacts and for competence development.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • To cite: Skånér Y, Nilsson GH, Arrelöv B, et al. Use and usefulness of guidelines for sickness certification: results from a national survey of all general practitioners in Sweden. BMJ Open 2011;1:e000303. doi:10.1136/bmjopen-2011-000303

  • Funding Funding sources were the Swedish Research Council of Working Life and Social Sciences, the Ministry of Health and Social Affairs, AFA Insurance and the National Social Insurance Agency. The sponsors were in no way involved in the design of the study, in the collection, analysis, interpretation of the data or in the writing and submitting of the article. All researchers have had access to all data.

  • Competing interests None.

  • Ethics approval The study was approved by the Regional Ethical Review Board of Stockholm (Reg. No. 2008/795-31).

  • Contributors All authors participated in the study design. EH performed the data management and statistical analyses. YS drafted the manuscript. All authors participated in interpretation of data and reviewed the manuscript. KA, GHN, BA and CL initiated the project and developed the questionnaire, and KA is the guarantor.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.