title: [Reasons for sick leave certifications: a case-control study of the Israeli Family Medicine Research Network (RAMBAM)].
abstract: BACKGROUND
  Sick-leave certification (SLC) is a legal document that provides official work exemption. In Israel, all SLCs are issued by primary care physicians. When providing a SLC, physicians are influenced by medical as well as nonmedical issues, such as the patients' psychosocial state and their workplace characteristics.
  
  
  OBJECTIVE
  To evaluate the explicit and implicit reasons for a SLC in Israeli primary care practices.
  
  
  METHODS
  A case-control prospective study was conducted in 47 urban primary care clinics in Israel. Patients of working age who received a SLC and a control group of consecutive patients without a SLC were included. Patients were interviewed by phone using a structured questionnaire, regarding their socio-demographic background, the duration of the SLC, their workplace characteristics, and their self-rated health status. The doctors completed a consent form, signed by the patients, incLuding the explicit and the implicit reason for providing a SLC.
  
  
  RESULTS
  Data was obtained from 918 patients; of these patients, 560 received a SLC and 358 were controls. The average duration of the SLC was 5.49 +/- 8.22 days, with a median of 3 days. The main explicit reasons for a SLC were: an acute medical problem (50%), and the patient's request (40%). The physicians' implicit reason was mainly the patient's request (84%). Self-employed workers and workers who do not receive payment for a full months work had significantly fewer SLCs. A Logistic regression model found younger age, salaried workers, entitlement for sick leave, special payment for a full months work, visiting for an acute illness or a request for SLC were the main factors significant in SLC provision.
  
  
  CONCLUSIONS
  Providing SLCs is a common task of primary physicians in Israel Most SLCs are for a short time, up to 3 days. Family physicians usually accept their patients' request for a SLC. Workplace regulations influence patients' and physicians' behaviors related to SLCs.
authors.affiliation: Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
authors.forename: Aya
authors.initials: A
authors.lastname: Biderman
authors.forename: Amalia
authors.initials: A
authors.lastname: Levy
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
mesh_terms: D000041:Absenteeism; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D017132:Workplace / Q000706:statistics & numerical data