Rates of sickness certification in European primary care: a systematic review

General practitioners (GPs) are responsible for assessing a patient's capacity for work and issuing a sickness certificate, enabling a patient to receive statutory sick pay and take time away from the workplace. The management of sickness absence across Europe varies considerably, and there is a need for comparable rates of certification to facilitate appropriate health and economic planning.

To systematically review the literature reporting rates of sickness certification in general practice settings.

Electronic databases were searched from their inception to November 2007. Inclusion criteria were reporting a measure of sickness certification, conducted in European primary care.

298 citations were identified from the literature search, of which 11 met the inclusion criteria. These studies demonstrated that the rates of sickness certification are not routinely recorded. The certified rates were subject to wide variation, ranging from 18 per 100 person years in Norway to 239 per 100 person years in Malta.

There is large variability in sickness certification policy and hence sickness certification rates across Europe. A system that enables comparisons across countries would be beneficial in ensuring health and economic planning. To enable a baseline rate of certification to be established and compared across countries, standardized reporting of sickness certification is needed.