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      Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland

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          Abstract

          Objectives

          Frequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs’ sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care.

          Setting and participants

          This is a longitudinal study using medical record data (2014–2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1–3, 4–14 and ≥15 days).

          Results

          Both occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension.

          Conclusion

          Both occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.

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          Most cited references37

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          Long term sickness absence.

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            Using administrative sickness absence data as a marker of future disability pension: the prospective DREAM study of Danish private sector employees.

            The aim of this study was to examine duration of sickness absence as a risk marker for future disability pension among all private sector employees in Denmark 1998-2004. All private sector employees receiving sickness absence compensation from the municipality in 1998, a total of 225 056 persons (39.2% women 61.8% men, age range 18-65, mean age 37.2), were followed in a national register to determine granted disability pension during the period 1 January 2001 through 31 December 2004. The authors excluded pensions in 1999 and 2000 to determine the status of sickness absence duration as an early risk marker. 5694 persons (2.5%) received disability pension during follow-up, more men (53.4%) than women (46.6%). There was a strong graded association between increasing length of absence and increasing risk of future disability pension. Significant differences were found between the younger and older age strata: men below 40 experiencing more than 26 weeks of sickness absence had a 16-fold risk of disability pension. The corresponding figure for men 40 years or older was approximately 7. For women, the corresponding figures were 12.6 and 6.7 respectively. The findings suggest that administratively collected data on sickness absence compensation are an important predictor of disability pension among private sector employees. The use of information on sick leave may improve the effectiveness of early interventions by policy makers, case managing authorities, employers and physicians.
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              Sickness absence as a risk marker of future disability pension: the 10-town study.

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                8 February 2019
                : 9
                : 2
                : e024980
                Affiliations
                [1 ] departmentFaculty of Medicine and Health Technology , Tampere University , Tampere, Finland
                [2 ] Pihlajalinna Työterveys , Tampere, Finland
                [3 ] departmentNew Social Research and Faculty of Social Sciences , Tampere University , Tampere, Finland
                [4 ] departmentDepartment of Public Health Sciences , Karolinska Institutet , Stockholm, Sweden
                [5 ] Finnish Institute of Occupational Health , Tampere, Finland
                [6 ] departmentClinic of Occupational Medicine , Tampere University Hospital , Tampere, Finland
                Author notes
                [Correspondence to ] Dr Tiia T M Reho; tiia.reho@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-6402-2055
                Article
                bmjopen-2018-024980
                10.1136/bmjopen-2018-024980
                6411255
                30782922
                dac5f9cd-8780-4ca7-96b9-81f1d1aee539
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 25 June 2018
                : 20 December 2018
                : 27 December 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004895, European Social Fund;
                Categories
                Public Health
                Research
                1506
                1724
                Custom metadata
                unlocked

                Medicine
                sickness absence,occupational health,primary health care,longitudinal studies,public health,access to health care

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