title: Trends of sickness certifications in primary health care in muscat, sultanate of oman.
abstract: OBJECTIVE
  Sickness certification (SC) is common practice in primary health care with proven implications on the health system. To assess the rate of sickness certifications in the Bowsher province and describe related demographic, occupational and medical factors.
  
  
  METHODS
  Our retrospective, cross-sectional study retrieved data for all consultations, with patients aged six to 65 years old, which ended with SC. The data from four primary health care centers in the Bowsher provice were collected during 2011 using the electronic medical record system. Collected data included patient demographics, occupation, date issued, duration of sickness certification, recorded vital signs, and clinical diagnosis. Suitable rates were calculated as percentages and important differences were compared using the chi-square test.
  
  
  RESULTS
  The total number of consultation visits for the targeted population was 189,275. Of these 26,096 consultations resulted in SC to a total of 15,758 patients. The overall rate of SC was 13.8 per 100 consultation-years (confidence interval (CI): 13.6-14). SC rates in males were significantly higher than females (17 and 11 per 100 consultations/year, respectively). Patients aged 19-29 years old had the highest rate of SC (18.6/100 consultations/year). School students aged six to 18 years made up 28% of patients, and 24% and 22% of patients were working in the private and public sectors, respectively. No vital signs record was found for 30% of SC visits. The highest rate of SC was in October (17%) and the lowest was in August (9%). Acute respiratory infections were the most frequent diagnoses (31%) resulting in certifications. The rate of SC issued for Omanis and non-Omanis was 14 and 9 per 100 consultations per year, respectively.
  
  
  CONCLUSIONS
  Sickness certification is a burden on primary health care in the studied health centers with approximately one in seven consultations ending with SC issued. More investigations are needed to identify determinates of high sickness absence. Robust guidelines are important to regulate the number of sickness certificates issued.
authors.affiliation: General Medicine, Bediyah Hospital, Bediyah, Oman.
authors.forename: Faiz
authors.initials: F
authors.lastname: A'Rashdy
authors.affiliation: General Medicine, Army Forces Health Services, Muscat, Oman.
authors.forename: Khamis
authors.initials: K
authors.lastname: Al-Hosni
authors.affiliation: Research Department, Oman Medical Specialty Board, Muscat, Oman.
authors.forename: Abdulhakeem
authors.initials: A
authors.lastname: Al-Rawahi
authors.affiliation: Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: Thord
authors.initials: T
authors.lastname: Theodorsson
keywords: Epidemiology; General Practice; Oman; Primary Health Care; Sick Leave; Sickness Certification