Shiels Christopher, Gabbay Mark B
Mersey Primary Care R&D Consortium, UK.
Scand J Public Health. 2007;35(3):250-6. doi: 10.1080/14034940601072364.
To investigate the association of patient, clinician, and general practice factors with long-term certified sickness absence.
Analysis of a sickness certification database constructed via the use of carbonized sick notes by clinicians at nine general practices in the north-west of England. A total of 3,385 patient sickness episodes certified by 44 general practitioners (GPs) were included in the analysis. Three logistic regression models were constructed in order to estimate independent effects of the patient, GP, and the general practice on risk of long-term (>28 weeks) incapacity.
The logistic regression models explained a maximum of 27% of the variation in long-term certified sickness. The diagnostic reason for the sickness episode explained over 18% of variance, while clinician and general practice effects explained only 3.4% and 2.3% respectively. In all models, older patient age and an episode within the mild mental disorder (MMD) diagnostic category significantly increased the risk of long-term work incapacity.
The study results imply that, rather than basing 'return to work' interventions on identification of individual patient/claimant characteristics or on GP training initiatives, it may be more productive to focus upon a more diagnosis-based approach within primary care itself. Interventions aiming to reduce mild mental disorder-related work incapacity should be given priority.
研究患者、临床医生及全科医疗因素与长期开具证明的病假之间的关联。
对英格兰西北部9家全科医疗诊所的临床医生使用复写病假条构建的病假证明数据库进行分析。分析纳入了44名全科医生（GP）开具证明的3385例患者病假事件。构建了三个逻辑回归模型，以估计患者、GP及全科医疗对长期（>28周）无工作能力风险的独立影响。
逻辑回归模型最多解释了长期开具证明病假中27%的变异。病假事件的诊断原因解释了超过18%的方差，而临床医生和全科医疗的影响分别仅解释了3.4%和2.3%。在所有模型中，患者年龄较大以及处于轻度精神障碍（MMD）诊断类别中的事件显著增加了长期无工作能力的风险。
研究结果表明，与其将“重返工作岗位”干预措施基于识别个体患者/索赔人的特征或GP培训计划，不如在初级医疗本身更专注于基于诊断的方法可能更有成效。应优先开展旨在减少与轻度精神障碍相关的无工作能力的干预措施。
