Sickness certification for patients with acute cough/LRTI in primary care in Poland and Norway

Abstract

Objective: To compare the frequency and duration of sickness certificates issued by GPs to Polish and Norwegian working adults with acute cough/lower respiratory tract infection (LRTI).

Design: Cross-sectional observational study with clinicians from nine primary care centres in Poland and 11 primary care centres in Norway. GPs filled out a case report form for all patients, including information on antibiotic prescribing, sickness certification, and advice to stay off work.

Setting: Primary care research networks in Poland and Norway.

Subjects: Working adults with a new or worsening cough or clinical presentation suggestive of LRTI.

Main outcome measures: Issuing sickness certificates and advising patients to stay off work.

Results: GPs recorded similar symptoms and signs in patients in the two countries. Antibiotics were prescribed more often in Polish than in Norwegian patients (70.4% vs. 27.1%, p < 0.0001). About half of the patients received a formal sickness certificate (50.5% in Norway and 52.0% in Poland). The proportion of patients advised to stay off work was significantly higher in the Polish sample compared with the Norwegian sample (75.2% vs. 56.1%, p = 0.002). Norwegian GPs less often issued sick certificates for more than seven days (5.6% vs. 36.9%, p < 0.0001).

Conclusion: The overall proportion of sickness certification for acute cough/LRTI was similar in Norwegian and Polish patients. However, in the Polish sample, GPs more often advised patients to take time off work without issuing a sick note. When sickness certificates were issued, duration of longer than seven days was more common in Polish than in Norwegian patients.

Figure 1.

Proportions of patients issued with a sickness certificate. Notes: Data were presented as percentage of cases related to the whole group of working adults with acute cough/LRTI from Poland (white bars, n = 125) and Norway (grey bars, n = 107). Error bars represent the 95% confidence interval (CI). #p < 0.02; *p < 0.03.

Figure 2.

Patients’ attendance related to weekdays. Notes: The percentage of work attendees visiting on different weekdays in Poland (n = 125) and Norway (n = 107) are shown as bars (in white and grey respectively) with 95% confidence interval (CI). The proportions that were sick-listed (n = 65 in Poland and n = 54 in Norway) on the different days are shown as lines.