title: Family Practitioners' Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks.
abstract: BACKGROUND
  Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours.
  
  
  OBJECTIVE
  to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries.
  
  
  METHODS
  Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression.
  
  
  RESULTS
  324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs' advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; P<0.001), fever (2.49; P<0.001), patients feeling generally unwell (2.21; P<0.001), antibiotic prescribing (1.51; P = 0.025) and auscultation abnormality (1.50; P = 0.029). Advice to take time off was not associated with patient reported recovery.
  
  
  CONCLUSIONS
  There is large variation in FPs' advice given to patients with LRTIs in Europe about taking time off work, which is not explained by differences in patients' reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed.
authors.affiliation: Centre for Family and Community Medicine, Division of Public Health, Medical University of Lodz, Lodz, Poland.
authors.forename: Maciek
authors.initials: M
authors.lastname: Godycki-Cwirko
authors.affiliation: Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Nocun
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: School of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: University Medical Center Utrecht, Julius Center for Health, Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
authors.affiliation: Centre for Trials Research, Cardiff University, Cardiff, United Kingdom.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
authors.forename: Nils
authors.initials: N
authors.lastname: Fleten
authors.affiliation: Centre for Family and Community Medicine, Division of Public Health, Medical University of Lodz, Lodz, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kowalczyk
authors.affiliation: General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
authors.forename: Hasse
authors.initials: H
authors.lastname: Melbye
mesh_terms: D000328:Adult; D005060:Europe; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012141:Respiratory Tract Infections; D057566:Self Report; D018582:Sick Leave