Open Access Research article

Quality of sickness certification in primary health care: a retrospective database study

Ylva Skånér1*, Britt Arrelöv12, Lars G Backlund1, Magdalena Fresk1, Amanda Waleh Åström2 and Gunnar H Nilsson1

Author Affiliations

1 Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden

2 Stockholm County Council, Stockholm, Sweden

For all author emails, please log on.

BMC Family Practice 2013, 14:48  doi:10.1186/1471-2296-14-48

Published: 12 April 2013



In the period 2004–2009, national and regional initiatives were developed in Sweden to improve the quality of sickness certificates. Parameters for assessing the quality of sickness certificates in primary health care have been proposed. The aim of this study was to measure the quality of sickness certification in primary health care by means of assessing sickness certificates issued between 2004 and 2009 in Stockholm.


This was a retrospective study using data retrieved from sickness certificates contained in the electronic patient records of 21 primary health care centres in Stockholm County covering six consecutive years. A total number of 236 441 certificates were used in the current study. Seven quality parameters were chosen as outcome measures. Descriptive statistics and regression models with time, sex and age group as explanatory variables were used.


During the study period, the quality of the sickness certification practice improved as the number of days on first certification decreased and the proportion of duly completely and acceptable certificates increased. Assessment of need for vocational rehabilitation and giving a prognosis for return to work were not significantly improved during the same period. Time was the most influential variable.


The quality of sickness certification practice improved for most of the parameters, although additional efforts to improve the quality of sickness certificates are needed. Measures, such as reminders, compulsory certificate fields and structured guidance, could be useful tools to achieve this objective.

General practitioners; Sick leave; Sickness certificates; Quality indicators; Health care