Background:Certifying physicians express their need for evidence-based guidelines with recommendations of duration of sickness absence. Since 2007 the National Board of Health and Welfare (NBHW) in Sweden provides such a national guideline for approximately 120 health conditions. The Insurance Medicine Decision Support (FMB) includes recommendations of expected duration of sickness absence, information about condition, prognosis, impairment, activity limitation and rehabilitation. In 2016 the National Board of Health and Welfare had the government commissions to update conditions related to psychiatric diagnoses.
Objectives:The aim of this presentation is to describe the work with updating 17 psychiatric diagnoses and highlight why ICF is an important tool to assess work ability.
Methods:Experts in medicine were nominated by the Swedish Society of Medicine. The experts reviewed the original recommendations and gave suggestions of revisions. Programme Officers at the NBHW compiled the suggestions. A final version was reached by consensus. Social Insurance medical advisors participated in the process. The International Classification of functioning, disability and health (ICF) was used to describe impairments (body functions) and activity limitations.
Results:The experts identified several needs of revision. The recommendations of duration of sickness absence were differentiated according to factors such as comorbidity and severity. In the mildest cases no sickness absence was recommended for 13 of the 17 diagnosis and in diagnoses with more severe cases the need for a longer sickness absence was recommended. Partial sick leave was recommended in a higher degree that earlier. For several diagnoses information about impairments and activity limitations was inadequate or lacking. This information was completed for all 17 psychiatric diagnoses and coded with ICF.
Conclusions:Information about impairments and activity limitations is important when assessing work ability and together with more individualised recommendations of duration of sickness absence FMB may constitute a support for professionals and administrator at the insurance organisation.