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Influence of local structural factors on physicians' sick-listing practice: a population-based study
Britt E Arrelöv1, Lars Borgquist, Kurt F Svärdsudd
1Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, Uppsala, Sweden. britt.arrelov@pubcare.uu.se
European Journal of Public Health
|August 30, 2005
Summary
Physician sick-listing practices vary significantly based on local factors, such as community size and hospital presence. These structural elements independently influence the duration of sick-leave certificates and episodes.
Area of Science:
- Social Medicine
- Health Services Research
- Public Health Policy
Background:
- Physicians act as gatekeepers for social security systems, including sick-listing.
- Previous studies indicate variability in physicians' sick-listing practices.
- The influence of local structural factors on these practices remains underexplored.
Purpose of the Study:
- To investigate whether local structural factors impact physicians' sick-listing practices.
- To quantify the relationship between community characteristics and sick-listing duration.
Main Methods:
- Analysis of 57,563 sick-listing certificates from eight Swedish counties.
- Inclusion of data from 1995 and 1996.
- Utilized county, community population size, and hospital presence as structural indicators; sick-listing certificate and episode length as outcome variables.
Main Results:
- Significant variation in sick-listing certificate and episode length was observed across counties, community sizes, and areas with/without hospitals.
- These variations persisted after adjusting for physician type, patient demographics, and diagnosis (case mix).
- Local structural factors were independently and significantly correlated with sick-listing duration.
Conclusions:
- Physicians' sick-listing practices are demonstrably influenced by local structural factors.
- The findings support the hypothesis that the healthcare environment shapes gatekeeping decisions in social security.