Effectiveness of problem-solving treatment by general practice registrars for patients with emotional symptoms.

INTRODUCTION: In general practice many patients present with emotional symptoms. Both patients and physicians desire effective non-pharmacological treatments. AIM: To study the effectiveness of problem-solving treatment (PST) delivered by trained general practice registrars (GP registrars) for patients with emotional symptoms. METHODS: In a controlled clinical trial we compared the effectiveness of PST versus usual care for patients with emotional symptoms. Dutch GP registrars provided either PST or usual care, according to their own preference. Patients were included if they (a) had presented for three or more consultations with emotional symptoms in the past six months; and (b) scored four or more on the 12-item General Health Questionnaire. Outcomes at three- and nine-month follow-up were standard measures of depression, anxiety and quality of life. RESULTS: Thirty-eight GP registrars provided PST and included 98 patients; 43 provided usual care and included 104 patients. PST patients improved significantly more than usual care patients: at nine-month follow-up, recovery rates for somatoform disorder and anxiety were higher in the PST group (OR 6.50, p=0.01 respectively OR 11.25, p=0.03). PST patients had improved significantly more on the domains social functioning, role limitation due to emotional problems and general health perception. DISCUSSION: Patients with emotional symptoms improved significantly more after PST delivered by motivated GP registrars than after usual care by GP registrars. Further research, with randomisation of interested registrars or interested GPs, is needed.

Yield of opportunistic targeted screening for type 2 diabetes in primary care: the diabscreen study.

PURPOSE: In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors. METHODS: In 11 family practices (total practice population = 49,229) in The Netherlands, we conducted a stepwise opportunistic screening program among patients aged 45 to 75 years by (1) identifying high-risk individuals (=1 diabetes risk factor) and low-risk individuals using the electronic medical record, (2) obtaining a capillary fasting plasma glucose measurement, repeated on a separate day if the value was greater than 110 mg/dL, and (3) obtaining a venous sample if both capillary fasting plasma glucose values were greater than 110 mg/dL and at least 1 sample was 126 mg/dL or greater. We calculated the yield (percentage of invited patients with undiagnosed diabetes), number needed to screen (NNS), and diagnostic value of the risk factors (odds ratio and area under the receiver operating characteristic curve). RESULTS: We invited for a first capillary measurement 3,724 high-risk patients seen during usual care and a random sample of 465 low-risk patients contacted by mail. The response rate was 90% and 86%, respectively. Ultimately, 101 high-risk patients (2.7%; 95% confidence interval [CI], 2.2%-3.3%; NNS = 37) and 2 low-risk patients (0.4%; 95% CI, 0.1%-1.6%; NNS = 233) had undiagnosed diabetes (P <.01). The prevalence of diabetes among patients 45 to 75 years old increased from 6.1% to 6.8% as a result. Among diagnostic models containing various risk factors, a model containing obesity alone was the best predictor of undiagnosed diabetes (odds ratio = 3.2; 95% CI, 2.0-5.2; area under the curve=0.63). CONCLUSIONS: The yield of opportunistic targeted screening was fair; obesity alone was the best predictor of undiagnosed diabetes. Opportunistic screening for type 2 diabetes in primary care could target middle-aged and older adults with obesity.

Detecting somatoform disorders in primary care with the PHQ-15.

PURPOSE: Because recognition and management of patients with somatoform disorders are difficult, we wanted to determine the specificity, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. METHODS: We studied the performance of the PHQ-15 in comparison with the Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis I disorders (SCID-I) as a reference standard. From January through September 2006, we approached patients for participation. This study was conducted in primary care settings in the Netherlands. Patients aged between 18 and 70 years were eligible if they belonged to 1 or more of the following groups: (1) patients with unexplained somatic complaints, (2) frequent attenders, and (3) patients with mental health problems. For the SCID-I interview we invited all patients with a PHQ-15 score of 6 or greater and a random sample of 30% of patients with a PHQ-15 score of less than 6. The primary study outcomes were the sensitivity and specificity for the validity and the kappa coefficient for the test-retest reliability. RESULTS: Of 2,147 eligible patients, 906 (42%) participated (mean age 48 years, 62% female). At a cutoff level of 3 or more severe somatic symptoms during the past 4 weeks, sensitivity was 78% and specificity 71%. The test-retest reliability was 0.60. CONCLUSIONS: The PHQ-15 is a valid and moderately reliable questionnaire for the detection of patients in a primary care setting at risk for somatoform disorders.

Screening for depression in high-risk groups: prospective cohort study in general practice.

BACKGROUND: Currently only about half of the people who have major depressive disorder are detected during regular health care. Screening in high-risk groups might be a possible solution. AIMS: To evaluate the effectiveness of selective screening for major depressive disorder in three high-risk groups in primary care: people with mental health problems, people with unexplained somatic complaints and people who frequently attend their general practitioner. METHOD: Prospective cohort study among 2005 people in high-risk groups in three health centres in The Netherlands. RESULTS: Of the 2005 people identified, 1687 were invited for screening and of these 780 participated. Screening disclosed 71 people with major depressive disorder: 36 (50.7%) already received treatment, 14 (19.7%) refused treatment and 4 individuals did not show up for an appointment. As a final result of the screening, 17 individuals (1% of 1687) started treatment for major depressive disorder. CONCLUSIONS: Screening for depression in high-risk populations does not seem to be effective, mainly because of the low rates of treatment initiation, even if treatment is freely and easily accessible.

What went and what came? Morbidity trends in general practice from the Netherlands.

BACKGROUND: Fourty years of morbidity registration in general practice is a milestone urging to present an overview of outcomes. This paper provides insight into the infrastructure and methods of the oldest practice-based research network in the Netherlands and offers an overview of morbidity in a general practice population. Changes in morbidity and some striking trends in morbidity are presented. METHODS: The CMR (Continuous Morbidity Registration) collects morbidity data in four practices, in and around Nijmegen, the Netherlands. The recording is anchored in the Dutch healthcare system, which is primary care based, and where every citizen is listed with a personal GP. Trends over the period 1985-2006 are presented as a three year moving average. As an indicator for 20-year prevalence trends we used the annual percentage change (APC). We restricted ourselves to morbidity, which is presented to the family physician on a frequent basis (overall prevalence rates >1.0/1000/year). RESULTS: The age distribution of the CMR population is comparable to the general Dutch population. Overall incidence figures vary between 1500/1000 ptyrs (men) and 2000/1000 ptyrs (women). They are quite stable over the years, whereas overall prevalence figures are rising gradually to 1500/2500 ptyrs (men) and 2000/3500 ptyrs (women). Increase in prevalence rates for chronic conditions is diffuse and gradual with a few striking exceptions. CONCLUSION: For morbidity patterns, the CMR database serves as a mirror of general practice. Practice-based research networks are indispensable for the development and maintenance of general practice as an academic discipline.

Skin diseases in family medicine: prevalence and health care use.

PURPOSE: Ongoing care for patients with skin diseases can be optimized by understanding the incidence and population prevalence of various skin diseases and the patient-related factors related to the use of primary, specialty, and alternative health care for these conditions. We examined the recent prevalence of skin diseases in a defined population of family medicine patients, self-reported disease-related quality of life, extent and duration of skin disease, and the use of health care by patients with skin diseases. METHODS: We undertook a morbidity registry-based epidemiological study to determine the prevalence of various skin diseases, using a patient questionnaire to inquire about health care use, within a network of family practices in the Netherlands with a practice population of approximately 12,000 citizens. RESULTS: Skin diseases accounted for 12.4% of all diseases seen by the participating family physicians. Of the 857 questionnaires sent to patients registered with a skin disease, 583 (68.0%) were returned, and 501 were suitable for analysis. In the previous year, 83.4% of the patients had contacted their family physician for their skin disease, 17.0% had contacted a medical specialist, and 5.2% had consulted an alternative health care practitioner. Overall, 65.1% contacted only their family physician. Patients who reported more severe disease and lower quality of life made more use of all forms of health care. CONCLUSION: This practice population-based study found that skin diseases account for 12.4% of diseases seen by family physicians, and that some skin problems may be seen more frequently. Although patients with more extensive skin diseases also obtain care from dermatologists, most patients have their skin diseases treated mainly by their family physician. Overall, patients with more severe disease and a lower quality of life seek more treatment.

A benzodiazepine discontinuation programme does not increase the frequency of contacts with the family practice.

OBJECTIVE: The efficacy of programmes to reduce long-term benzodiazepine use could be compromised by subsequent increases in contacts with the family practice. In this study the hypothesis was tested as to whether participation in a benzodiazepine discontinuation programme affects the frequency of contacts with the family practice. DESIGN: A controlled stepped-care intervention programme to decrease long-term benzodiazepine use. SETTING: Family practices in the Netherlands. Subjects. The experimental group consisted of 996 long-term benzodiazepine users and a control group of 883 long-term benzodiazepine users. MAIN OUTCOME MEASURES: Practice contacts before and up to 12 months after the start of the programme. RESULTS: There was a general tendency visible for contacts to decrease during the follow-up time. The course of the number of contacts during the follow-up was not different for the experimental and control groups (p=0.45). The level of non-benzodiazepine prescriptions was generally not altered. The number of non-benzodiazepine prescriptions decreased in benzodiazepine quitters during the follow-up of the programme. CONCLUSION: No clinically important differences in practice contacts were observed when the course of the number of contacts and non-benzodiazepine prescriptions were compared between the experimental and control groups. Family practitioners do not have to anticipate an increased workload associated with participation in such a benzodiazepine discontinuation programme.

General practice registrars and research - attitudes toward participation.

BACKGROUND: Early exposure of general practitioners to research is recommended to increase family medicine research capacity. However, vocational training programs encounter difficulties in engaging general practice registrars in research projects. The authors investigated registrars' opinions of research and their participation in research in daily practice. METHODS: Sixty-seven Dutch general practice registrars participated in a trial concerning patients with emotional symptoms. The authors assessed the registrars' participation and opinions through observation and a questionnaire. RESULTS: Response rate was 82%. Registrars recruited 208 patients. The participants liked learning a new skill and participating in research. Obligatory participation, lack of time and difficulties with patient recruitment were important barriers to participation. DISCUSSION: Registrars report that participation in research during vocational training is interesting but that it should not be compulsory, and that they prefer to choose their own research subjects. The authors recommend implementing an attractive research program during vocational training.

Changes in the sociodemographic composition of the lowest socioeconomic group over time, 1987-2001.

BACKGROUND: When comparing health differences of groups with equal socioeconomic status (SES) over time, the sociodemographic composition of such a SES group is considered to be constant. However, when the periods are sufficiently spaced in time, sociodemographic changes may have occurred. The aim of this study is to examine in which respects the sociodemographic composition of lowest SES group changed between 1987 and 2001. METHODS: Our data were derived from the first and second Dutch National Survey of General Practice conducted in 1987 and 2001. In 1987 sociodemographic data from all listed patients (N = 334,007) were obtained by filling out a registration form at the practice (response 78.3%, 261,691 persons), in 2001 these data from all listed patients (385,461) were obtained by postal survey (response 76.9%, 296,243 persons). Participants were primarily classified according to their occupation into three SES groups: lowest, middle and highest. RESULTS: In comparison with 1987, the lowest SES group decreased in relative size from 34.9% to 29.5%. Within this smaller SES group, the relative contribution of persons with a higher education more than doubled for females and doubled for males. This indicates that the relation between educational level and occupation was less firmly anchored in 2001 than in 1987. The relative proportion of some disadvantaged groups (divorced, unemployed) increased in the lowest SES group, but the size of this effect was smaller than the increase from higher education. Young people (0-24 years) were proportionally less often represented in the lowest SES group. Non-Western immigrants contributed in 2001 proportionally less to the lowest SES group than in 1987, because of an intergenerational upward mobility of the second generation. CONCLUSION: On balance, the changes in the composition did not result in an accumulation of disadvantaged groups in the lowest SES group. On the contrary, the influx of people with higher educational qualifications between 1987 and 2001 could result in better health outcomes and health perspectives of the lowest SES group.

Identifying people at risk for undiagnosed type 2 diabetes using the GP's electronic medical record.

BACKGROUND: Screening for type 2 diabetes is recommended in at-risk patients. The GP's electronic medical record (EMR) might be an attractive tool for identifying them. OBJECTIVE: To assess the value of the GP's EMR in identifying patients at risk for undiagnosed type 2 diabetes and the feasibility to use this information in usual care to initiate screening. METHODS: In 11 Dutch general practices (25 GPs), we performed an EMR-derived risk assessment in all patients aged > or =45 and < or =75 years, without known diabetes, identifying those at risk according to the American Diabetes Association recommendations. Patients with an EMR-derived risk or risk after additional risk assessment during regular consultation were invited for capillary fasting plasma glucose (FPG) measurement. RESULTS: Of 13 581 patients, 3858 (28%) had an EMR-based risk (hypertension, cardiovascular disease, lipid metabolism disorders and/or obesity). Additional risk assessment in those without an EMR-based risk showed that in 51%, greater than one risk factor was present, mainly family history (51.2%) and obesity (59%). Ninety per cent returned for the FPG measurement. In both groups, we found patients with an FPG exceeding the cut point for diabetes (5.9% versus 4.1%). CONCLUSIONS: With additional risk assessment during consultation, the GP's EMR was valuable in identifying patients at risk for undiagnosed type 2 diabetes. It was feasible to use this information to initiate screening. At-risk patients were willing to take part in screening. Better registration of family history and obesity will improve the EMR as a tool for identifying at-risk patients in opportunistic screening in general practice.

The dieting dilemma in patients with newly diagnosed type 2 diabetes: does dietary restraint predict weight gain 4 years after diagnosis?

OBJECTIVE: To examine whether dieting--restriction of food intake for the purpose of weight control--suppresses or promotes excessive food intake and weight gain. DESIGN: A 4-year follow-up study of a dietary intervention in a sample of 97 patients with newly diagnosed Type 2 diabetes. MAIN OUTCOME MEASURES: Weight gain, change in body mass index (measured weight in kilograms divided by measured height squared), and intake of energy, as measured with a food frequency questionnaire, were assessed in relation to dietary restraint and tendency to overeat (emotionally or externally induced overeating), as assessed with the Dutch Eating Behaviour Questionnaire. RESULTS: Tendency to overeat at diagnosis and not dietary restraint was associated with weight gain and intake of energy 4 years after diagnosis. CONCLUSION: These findings suggest that the success of a dietary intervention can be predicted by a subject's tendency toward overeating. The possibility of matched treatment of obesity is discussed on the basis of the distinction between patients with a low versus a high tendency to overeat.

Uptake of cervical cancer screening in The Netherlands is mainly influenced by women's beliefs about the screening and by the inviting organization.

BACKGROUND: This study aims to examine the impact of women's characteristics (demographics, risk behaviour, and beliefs) on the uptake of cervical cancer screening, taking practice characteristics (demographic and organizational) into account. METHODS: Routinely collected data of screening status were sampled from electronic medical records of 32 Dutch general practices. Additionally, a questionnaire was sent to a sample of 2224 listed women-1204 screened, 1020 unscreened. We used a step-by-step, logistic, multilevel approach to examine determinants of the screening uptake. RESULTS: Analyses of data for 1392 women (968 screened and 424 unscreened) showed that women's beliefs about cervical screening and attendance are the best predictors of screening uptake, even when demographic and organizational aspects are taken into account. Women aged 40-50 years who felt high personal moral obligation, who had only one sexual partner ever, and who were invited and reminded by their own general practice had the greatest likelihood of screening uptake. A non-response study was performed; the non-responders to the questionnaire (mainly unscreened) thought they had less risk of cervical cancer, were less motivated, less often intended to get future screening, and were more convinced that cervical cancer cannot be cured. CONCLUSION: To improve the uptake rate, we should focus on the personal moral obligation of eligible women, beliefs about the risks of cervical cancer, and available cures. Invitations and reminders within general practices enhance the uptake rate.

Screening for type 2 diabetes in primary care using a stepwise protocol: the Diabscreen study.

AIM: To evaluate a stepwise protocol in opportunistic screening for type 2 diabetes. METHODS: From 2000 to 2001, in 11 Dutch general practices (n=49,229) we invited at-risk patients during usual care for a capillary fasting plasma glucose (cFPG1) measurement. If >6.0 mmol/l, a second sample (cFPG2) was taken on another day, followed by a venous sample (vFPG) if cFPG2>6.0 mmol/l and cFPG1 or 2> or =7.0 mmol/l. RESULTS: Of 3724 at-risk patients invited for a cFPG1, 3335 (90%) returned for the measurement. Ultimately, in 125 (4%) of them a vFPG was measured. In 101 out of 125 patients the vFPG was > or =7.0 mmol/l, giving a positive predictive value of our protocol of 81%. CONCLUSION: A stepwise screening protocol including two subsequent capillary blood glucose measurements from a portable blood glucose meter is well applicable in screening for type 2 diabetes in primary care.

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial.

AIM: To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-six intervention and 23 control primary care practices in the Netherlands. METHOD: Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. RESULTS: Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. CONCLUSION: The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument.

Continuity of care through medical records--an explorative study on GPs' management considerations.

BACKGROUND: The growing complexity of care with more professionals involved is a threat to the delivery of coherent and consistent care. Excellent exchange of information between professionals may be a way to maintain continuity of care. Relevant information to be passed over includes thoughts about future management for individual patients. AIM: To explore the nature of GPs' thoughts about future management, and to determine the extent to which such thoughts are actually recorded in medical records. DESIGN OF STUDY: Cross-sectional study of 5741 consultations. SETTING: Thirty GPs from 17 practices in a region in the eastern part of The Netherlands. METHODS: The GPs responded to an electronic questionnaire, directly after 200 successive consultations. The questionnaire included items on management considerations, consultation characteristics and personal continuity. We compared the data from the questionnaire to the actual recording of management considerations in the patient records. RESULTS: The GPs had management considerations in 66.4% of the consultations, involving mainly considerations about additional testing (15.5%), adjustment of medication (22.5%), alternative treatment plans (18.6%), possible referral (11.8%) and coping behaviour (18.0%). These considerations were seldom recorded in the electronic patient record; additional testing (3.0%) adjustment of medication (2.9%) and alternative treatment plans (4.1%). Surprisingly however, GPs rarely found that management considerations from earlier consultations were lacking in the medical record. CONCLUSION: GPs often have thoughts on how to deal with this patient, but hardly ever record such considerations. We recommend the development of tools that facilitate the recording of management considerations in electronic patient records.

Long-term outcome of cardiovascular prevention: a Nijmegen Academic Family Practices Network study.

CONTEXT: Cardiovascular disease is common and preventable. Primary care is the preferred setting for individual prevention and management. OBJECTIVE: This study analyzed the long-term outcome of cardiovascular risk in a family practice population. DESIGN: A longitudinal cohort analysis of cardiovascular outcome after 18 years, in participants of a randomized controlled trial (RCT) of cardiovascular prevention. In 1977, a RCT with cluster randomization at practice level assessed the effects of a 1-year preventive intervention in patients 20 to 50 years of age. Cardiovascular risk factors (smoking, body mass index, blood pressure, serum cholesterol, family history, and physical activity) were measured and intervention was a practice-nurse support for the follow-up of those at elevated risk. The control practices prescribed care as usual. Between 1994 and 1995, all participants were approached again, to analyze subsequent (cardiovascular) mortality and morbidity and their cardiovascular risk in a random sample. SETTING: The Nijmegen Academic Family Practices Network, The Netherlands. PARTICIPANTS: All participants (7092) of the 1977 screening for follow-up morbidity and mortality, 2600 for re-measurement risk factors. OUTCOME MEASURES: Cardiovascular risk factors; cardiovascular morbidity and mortality 1977-1995. RESULTS: Follow-up was achieved in 5945 participants (84%) and 2335 participated in the re-measurement (89%). No effects of the preventive intervention were found, but those initially at low risk profile were still so 18 years later. Risk of subsequent cardiovascular mortality and morbidity was related to baseline risk, but for women, the absolute risk was low in all risk strata and lower than predicted from international references. CONCLUSIONS: This study demonstrated the feasibility of family practice network research in pursuing longitudinal research. A single cardiovascular screening resulted in reliable risk assessment: those initially at low risk still were so after 18 years. Effects of a 1-year intensive intervention could no longer be demonstrated.

Vocational and working career of asthmatic adolescents is only slightly affected.

INTRODUCTION: The aim of this study was to investigate whether teenagers and adolescents (10-22 years) with asthma or asymptomatic bronchial hyperresponsiveness, were more likely to experience vocational or professional career limitations in the future, as compared to non-asthmatic contemporaries. METHODS: Data were used from a 14-year follow-up study in general practice, investigating the relationship between respiratory health in childhood and adolescence. At follow-up, the respiratory health status and information about career limitations were obtained. RESULTS: There were no statistical significant differences between asthmatics (n=52) and non-asthmatics (n=154) in the proportion currently employed subjects, or contract type. Most examined career limitations were infrequently reported in both groups, but seemed to occur slightly more frequent among asthmatics. Asthmatics seemed to have an increased risk for limitations in daily activities both attributable to their respiratory health (OR=2.6, 95% CI [1.0; 7.0]) and all-cause (OR=1.8, 95% CI [0.9; 3.3]), and for absence from work all-cause (OR=1.7, 95% CI [0.9; 3.3]). However, the differences were in most cases in the magnitude of only a few days per year. Neither lung function nor bronchial hyperresponsiveness did predict absence from work, or limitations in daily activities. CONCLUSION: Asthmatic young adults seem to experience somewhat more limitations in their vocational and professional careers. Nonetheless, the majority of the young asthmatics seem to be only slightly limited in their careers. In non-asthmatic young adults the presence of asymptomatic bronchial hyperresponsiveness does not seem to lead to career limitations.

First myocardial infarction in a Dutch general practice population: trends in incidence from 1975-2003.

BACKGROUND: As morbidity registrations generally do not make distinct first and following myocardial infarctions, it is still unclear as to what extent the falling rates of myocardial infarctions are caused by lower incidences of first myocardial infarctions. AIM: To investigate the incidence of first myocardial infarctions in a general practice population. METHOD: Data were taken from the Continuous Morbidity Registration (CMR) Nijmegen, which has been collecting data from four general practices since 1971. For the 1975-2003 period, sex-specific and age-specific yearly incidence rates were obtained from the registration data of the CMR. Trends were studied with Poisson regression. RESULTS: During the study period, 827 patients with a first myocardial infarction were identified. The incidence of first myocardial infarctions has declined since 1986 to 2.1 per 1000 for men and to 1.5 per 1000 for women. The average age of getting a first myocardial infarction increased with 3 years for men and slightly decreased for women. Since 1986, the incidence of sudden cardiac death from a first myocardial infarction has considerably declined for men and women to 0.9 and 0.7 per 1000 respectively. CONCLUSION: A slight, significant, decline in incidence of first myocardial infarctions was found. From the mid eighties a mean annual decline of 3.5% in death from first myocardial infarction was observed. Though the variance in rates of coronary heart diseases is not unambiguous, this may indicate an effect of primary prevention. The decline was more pronounced in men, with an increasing age of getting a first myocardial infarction.

Sick leave in patients with obstructive lung disease is related to psychosocial and work variables rather than to FEV1.

The aim of this exploratory study was to investigate associations between sick leave in workers with asthma or COPD and disease-related variables, psychosocial variables, and work characteristics. Hundred and eighty-nine patients with physician-diagnosed asthma (N=118) or COPD (n=71) who had paid work in the past 12 months completed questionnaires on sick leave, health complaints, functional limitations, work characteristics and psychosocial issues, and underwent a pulmonary function test (FEV1 and FVC before and after bronchodilation). Logistic regression analyses were performed to investigate variables independently associated with high sick leave (i.e. more than twice a year and/or longer than 1 month per episode). Asthma patients, not having an emotionally difficult job, with low job satisfaction, who had changed employers, utilized job control, and who encountered pulmonary aggravating factors at work were found to have a higher incidence of sick leave. COPD patients, who had informed the employer or colleagues about the disease, who did not have difficult tasks at work, who did not hide dyspnea and limitations, and who reported high fatigue were showing higher sick leave. FEV1 and FVC were not associated with sick leave in either group. It was concluded that psychosocial variables, work characteristics, functional limitations, and complaints play a more important role in sick leave in workers with asthma and COPD than FEV1.