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The cost of saying no: general practitioners' gatekeeping role in sickness absence certification.

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  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: London : BioMed Central, [2001-
    • الموضوع:
      General Practitioners*; Humans ; Gatekeeping ; Focus Groups ; Referral and Consultation ; Certification ; Sick Leave ; Work Capacity Evaluation ; Attitude of Health Personnel
    • نبذة مختصرة :
      Background: General practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification.
      Methods: Qualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke's thematic analysis approach.
      Results: Our results indicate that GPs' sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs' opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs' available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence.
      Conclusion: Our study suggests that GPs' decisions about sickness certification is largely driven by patient preferences. The GPs' gatekeeping function is limited to negotiations about grade and duration of absence spells.
      (© 2024. The Author(s).)
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    • Contributed Indexing:
      Keywords: Gatekeeping; General practitioners; Sickness absence
    • الموضوع:
      Date Created: 20240212 Date Completed: 20240214 Latest Revision: 20240215
    • الموضوع:
      20240215
    • الرقم المعرف:
      PMC10860288
    • الرقم المعرف:
      10.1186/s12889-024-17993-1
    • الرقم المعرف:
      38347474