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      Unsanctioned techniques for having sickness certificates accepted: a qualitative exploration and description of the strategies used by Swedish general practitioners

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          Abstract

          Objectives: To explore informal and unsanctioned techniques general practitioners (GPs) employ as a means to increase the likelihood of sickness certificate approval, following the Swedish Social Insurance Agency’s (SSIA’s) consolidation of the gatekeeping role in sickness benefit evaluation.

          Design: Qualitative semi-structured interviews with 20 GPs working in Swedish primary care. A thematic analysis of the transcribed material was carried out to map different techniques employed by the practitioners.

          Results: Eight techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. The identified techniques were most commonly adopted when the patient’s case was perceived to be at high risk for rejection by the SSIA (such as psychiatric illnesses, chronic pain etc.).

          Conclusions: The findings imply that the informal and unsanctioned techniques are complex and ambiguous. They are used intentionally and covertly. The study also suggests that, while the consolidation of SSIA’s gatekeeping role may have resolved some sickness absence issues, a consequence may be that GPs develop unsanctioned techniques to ensure compliance.

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          Methods of data collection in qualitative research: interviews and focus groups.

          This paper explores the most common methods of data collection used in qualitative research: interviews and focus groups. The paper examines each method in detail, focusing on how they work in practice, when their use is appropriate and what they can offer dentistry. Examples of empirical studies that have used interviews or focus groups are also provided.
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            Conceptualizing Resistance

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              Using thematic analysis in psychology

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                Author and article information

                Journal
                Scand J Prim Health Care
                Scand J Prim Health Care
                IPRI
                ipri20
                Scandinavian Journal of Primary Health Care
                Taylor & Francis
                0281-3432
                1502-7724
                March 2019
                28 January 2019
                : 37
                : 1
                : 10-17
                Affiliations
                Centre for Studies in Practical Knowledge, Södertörn University , Stockholm, Sweden
                Author notes
                CONTACT Mani Shutzberg mani.shutzberg@ 123456sh.se Centre for Studies in Practical Knowledge, Södertörn University , Stockholm, Sweden
                Article
                1569426
                10.1080/02813432.2019.1569426
                6454410
                30689481
                f3b69ada-450b-410e-8a97-9cc6488106a1
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 July 2018
                : 21 November 2018
                Page count
                Figures: 0, Tables: 0, Pages: 8, Words: 5424
                Categories
                Original Article

                family practice,non-compliance,praxis,qualitative research,sickness certification,sweden

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