Independent medical evaluation of general practitioners' follow-up of sick-listed patients: a cross-sectional study in Norway

Irene Øyeflaten, Silje Maeland, Inger Haukenes, Irene Øyeflaten, Silje Maeland, Inger Haukenes

Abstract

Objectives: The study was designed to examine the sufficiency of general practitioners' (GPs) follow-up of patients on sick leave, assessed by independent medical evaluators.

Design: Cross-sectional study SETTING: Primary health care in the Western part of Norway. The study reuses data from a randomised controlled trial-the Norwegian independent medical evaluation trial (NIME trial).

Participants: The intervention group in the NIME trial: Sick-listed workers having undergone an independent medical evaluation by an experienced GP at 6 months of unremitting sick leave (n=937; 57% women). In the current study, the participants were distributed into six exposure groups defined by gender and main sick leave diagnoses (women/musculoskeletal, men/musculoskeletal, women/mental, men/mental, women/all other diagnoses and men/all other diagnoses).

Outcome measure: The independent medical evaluators assessment (yes/no) of the sufficiency of the regular GPs follow-up of their sick-listed patients.

Results: Estimates from generalised linear models demonstrate a robust association between men with mental sick leave diagnoses and insufficient follow-up by their regular GP first 6 months of sick leave (adjusted relative risk (RR)=1.8, 95% CI=1.15-1.68). Compared with the reference group, women with musculoskeletal sick leave diagnoses, this was the only significant finding. Men with musculoskeletal diagnoses (adjusted RR=1.4, 95% CI=0.92-2.09); men with other diagnoses (adjusted RR=1.0, 95% CI=0.58-1.73); women with mental diagnoses (adjusted RR=1.2, 95% CI=0.75-1.77) and women with other diagnoses (adjusted RR=1.3, 95% CI=0.58-1.73).

Conclusions: Assessment by an independent medical evaluator showed that men with mental sick leave diagnoses may be at risk of insufficient follow-up by their GP. Efforts should be made to clarify unmet needs to initiate relevant actions in healthcare and work life. Avoiding marginalisation in work life is of the utmost importance.

Trial registration number: NCT02524392; Post-results.

Keywords: primary care; quality in health care; rehabilitation medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Wynne-Jones G, Mallen CD, Main CJ, et al. . What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care 2010;28:67–75. 10.3109/02813431003696189
    1. Aamland A, Maeland S. Primary care physicians’ attitudes to and experiences with sick leave and follow-up a scoping review. Tidsskr Velferdsforskn 2016;19:148–78.
    1. Hulshof C, Pransky G. The Role and Influence of Care Providers on Work Disability : Loisel P, Anema JR, Handbook of work disability. New York: Springer, 2013: 203–15.
    1. Brage S, Kann I. Fastlegers sykmeldingspraksis I: Variasjoner(GP's sickenss certification parctice: variations). Oslo: Rikstrygdeverket, 2006.
    1. Husabo E, Monstad K, Holmås TH, et al. . Protocol for the effect evaluation of independent medical evaluation after six months sick leave: a randomized controlled trial of independent medical evaluation versus treatment as usual in Norway. BMC Public Health 2017;17:57310.1186/s12889-017-4469-3
    1. Koopmans PC, Roelen CA, Bültmann U, et al. . Gender and age differences in the recurrence of sickness absence due to common mental disorders: a longitudinal study. BMC Public Health 2010;10:42610.1186/1471-2458-10-426
    1. Leijon M, Hensing G, Alexanderson K. Sickness absence due to musculoskeletal diagnoses: association with occupational gender segregation. Scand J Public Health 2004;32:94–101. 10.1080/14034940310006195
    1. Mastekaasa A. The gender gap in sickness absence: long-term trends in eight European countries. Eur J Public Health 2014;24:656–62. 10.1093/eurpub/cku075
    1. Mastekaasa A, Melsom AM. Occupational segregation and gender differences in sickness absence: evidence from 17 European countries. Eur Sociol Rev 2014;30:582–94. 10.1093/esr/jcu059
    1. Borkhoff CM, Hawker GA, Kreder HJ, et al. . The effect of patients' sex on physicians' recommendations for total knee arthroplasty. CMAJ 2008;178:681–7. 10.1503/cmaj.071168
    1. Bösner S, Haasenritter J, Hani MA, et al. . Gender bias revisited: new insights on the differential management of chest pain. BMC Fam Pract 2011;12:4510.1186/1471-2296-12-45
    1. Bugiardini R, Estrada JLN, Nikus K, et al. . Gender bias in acute coronary syndromes. Curr Vasc Pharmacol 2010;8:276–84. 10.2174/157016110790887018
    1. Chang AM, Mumma B, Sease KL, et al. . Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk. Acad Emerg Med 2007;14:599–605. 10.1197/j.aem.2007.03.1355
    1. Crilly M, Bundred P, Hu X, et al. . Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care. BMC Health Serv Res 2007;7:14210.1186/1472-6963-7-142
    1. Hamberg K, Risberg G, Johansson EE, et al. . Gender bias in physicians' management of neck pain: a study of the answers in a Swedish national examination. J Womens Health Gend Based Med 2002;11:653–66. 10.1089/152460902760360595
    1. Nyberg F, Osika I, Evengård B. "The Laundry Bag Project"--unequal distribution of dermatological healthcare resources for male and female psoriatic patients in Sweden. Int J Dermatol 2008;47:144–9. 10.1111/j.1365-4632.2008.03485.x
    1. OECD Sickness, Disability and Work: Breaking the Barriers : A synthesis of findings acrossOECD countries. OECD Publishing, 2010.
    1. Album D, Westin S. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med 2008;66:182–8. 10.1016/j.socscimed.2007.07.003
    1. Wijnhoven HAH, de Vet HCW, Picavet HSJ. Prevalence of musculoskeletal disorders is systematically higher in women than in men. Clin J Pain 2006;22:717–24. 10.1097/01.ajp.0000210912.95664.53
    1. The Norwegian Ministry of Health and Care Services The introduction of a regular GP scheme. Oslo, 2001.
    1. Aamland A, Husabo E, Maeland S. Independent medical evaluation for sick-listed patients: a focus group study of GPs' expectations and experiences. BMC Health Serv Res 2018;18:66610.1186/s12913-018-3481-3
    1. Silje M. Forsøk Med NY medisinsk vurdering (NMV) etter seks måneders sykmelding (new medical evaluation (NMV) after six months sickness absence). Bergen, Norway: Norce - Norwegian Research Centre, 2018.
    1. World Health Organisation International classification of primary care (ICPC-2). 2 edn, 2003.
    1. Norway S. International Standard Classification of Occupation (ISCO-88(COM)), 1999.
    1. Eriksson R, Concepts GJH. Data, and Strategies of Enquiry : The Constant Flux: A Study of Class Mobility in Industrial Societies. Oxford: University of Oxford, 1992: 28–64.
    1. Krokstad S, Westin S. Disability in society-medical and non-medical determinants for disability pension in a Norwegian total County population study. Soc Sci Med 2004;58:1837–48. 10.1016/S0277-9536(03)00409-X
    1. Leinonen T, Pietiläinen O, Laaksonen M, et al. . Occupational social class and disability retirement among municipal employees--the contribution of health behaviors and working conditions. Scand J Work Environ Health 2011;37:464–72. 10.5271/sjweh.3182
    1. Grant RL. Converting an odds ratio to a range of plausible relative risks for better communication of research findings. BMJ 2014;348:f745010.1136/bmj.f7450
    1. Talbot D, Massamba VK. A descriptive review of variable selection methods in four epidemiologic journals: there is still room for improvement. Eur J Epidemiol 2019;34:725–30. 10.1007/s10654-019-00529-y
    1. Hernán MA, Hernández-Díaz S, Werler MM, et al. . Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol 2002;155:176–84. 10.1093/aje/155.2.176
    1. Bristow K, Edwards S, Funnel E, et al. . Help Seeking and Access to Primary Care for People from "Hard-to-Reach" Groups with Common Mental Health Problems. Int J Family Med 2011;2011:1–10. 10.1155/2011/490634
    1. Kovess-Masfety V, Boyd A, van de Velde S, et al. . Are there gender differences in service use for mental disorders across countries in the European Union? results from the EU-World mental health survey. J Epidemiol Community Health 2014;68:649–56. 10.1136/jech-2013-202962
    1. Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs 2005;49:616–23. 10.1111/j.1365-2648.2004.03331.x
    1. Vesga-López O, Schneier FR, Wang S, et al. . Gender differences in generalized anxiety disorder: results from the National epidemiologic survey on alcohol and related conditions (NESARC). J Clin Psychiatry 2008;69:1606–16.
    1. Harris MG, Diminic S, Reavley N, et al. . Males' mental health disadvantage: an estimation of gender-specific changes in service utilisation for mental and substance use disorders in Australia. Aust N Z J Psychiatry 2015;49:821–32. 10.1177/0004867415577434
    1. Hensing G, Alexanderson K, Allebeck P, et al. . Sick-leave due to psychiatric disorder: higher incidence among women and longer duration for men. Br J Psychiatry 1996;169:740–6. 10.1192/bjp.169.6.740
    1. Samulowitz A, Gremyr I, Eriksson E, et al. . "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag 2018;2018:1–14. 10.1155/2018/6358624
    1. Aamland A, Øyeflaten I, Maeland S. Independent medical evaluation for sick-listed workers in Norway: a focus group study of the experience of IME doctors. Scand J Public Health 2019;47:70–7. 10.1177/1403494817745001
    1. Maeland S, Werner EL, Rosendal M, et al. . Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: a cross-sectional study in Norway, Sweden, and Denmark. Scand J Prim Health Care 2013;31:227–34. 10.3109/02813432.2013.844412
    1. Nilsen SM, Ernstsen L, Krokstad S, et al. . Educational inequalities in disability pensioning - the impact of illness and occupational, psychosocial, and behavioural factors: The Nord-Trøndelag Health Study (HUNT). Scand J Public Health 2012;40:133–41. 10.1177/1403494811435494
    1. Ihlebaek C, Brage S, Eriksen HR. Health complaints and sickness absence in Norway, 1996-2003 : Occupational medicine. 57 England: Oxford, 2007: 43–9.
    1. Reme SE, Tangen T, Moe T, et al. . Prevalence of psychiatric disorders in sick listed chronic low back pain patients. Eur J Pain 2011;15:1075–80. 10.1016/j.ejpain.2011.04.012
    1. Knapstad M, Øverland S, Henderson M, et al. . Shame among long-term sickness absentees: correlates and impact on subsequent sickness absence. Scand J Public Health 2014;42:96–103. 10.1177/1403494813500590
    1. Knudsen AK, Hotopf M, Skogen JC, et al. . The health status of nonparticipants in a population-based health study: the Hordaland health study. Am J Epidemiol 2010;172:1306–14. 10.1093/aje/kwq257
    1. Korkeila K, Suominen S, Ahvenainen J, et al. . Non-Response and related factors in a nation-wide health survey. Eur J Epidemiol 2001;17:991–9. 10.1023/A:1020016922473
    1. Knudsen AK, Øverland S, Hotopf M, et al. . Lost working years due to mental disorders: an analysis of the Norwegian disability pension registry. PLoS One 2012;7:e4256710.1371/journal.pone.0042567

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