Productivity Loss Due to Presenteeism Among Patients with Arthritis: Estimates from 4 Instruments

University of Toronto, Toronto, Ontario, Canada
The Journal of Rheumatology (Impact Factor: 3.19). 09/2010; 37(9):1805-14. DOI: 10.3899/jrheum.100123
Source: PubMed


To estimate and compare lost work hours attributable to presenteeism, defined as reduced productivity while working, in individuals with osteoarthritis (OA) or rheumatoid arthritis (RA), according to 4 instruments.
In our prospective study, 250 workers with OA (n = 130) or RA (n = 120) were recruited from community and clinical sites. Lost hours due to presenteeism at baseline were estimated using the Health and Labor Questionnaire (HLQ), the Work Limitations Questionnaire (WLQ), the World Health Organization's Health and Work Performance Questionnaire (HPQ), and the Work Productivity and Activity Impairment Questionnaire (WPAI). Only those respondents working over the past 2 weeks were included. Repeated-measures ANOVA was used to compare the lost-time estimates, according to each instrument.
Of the 212 respondents included in the analyses, the frequency of missing and "0" values among the instruments was different (17% and 61% for HLQ, 8% and 5% for WLQ, 1% and 16% for HPQ, 0% and 27% for WPAI, respectively). The average numbers of lost hours (SD) per 2 weeks due to presenteeism using HLQ, WLQ, HPQ, and WPAI were 1.6 (3.9), 4.0 (3.9), 13.5 (12.5), and 14.2 (16.7). The corresponding costs for the 2-week period were CAN$30.03, $83.05, $284.07, and $285.10. The differences in the lost-hour estimates according to instruments were significant (p < 0.001).
Among individuals with arthritis, estimates of productivity losses while working vary widely according to the instruments chosen. Further research on instrument design and implications for a standardized approach to estimate lost time due to presenteeism is needed.

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    • "In so doing, the proposed targets acknowledge the patient’s ‘cost’ associated with waiting. This cost is difficult to define, though in CKD, it may include productivity losses associated with absenteeism and presenteeism [23,24] as well as the intangible psychological impact of uncertainty when faced with a significant health concern. "
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    ABSTRACT: Early referral and management of high-risk chronic kidney disease may prevent or delay the need for dialysis. Automatic eGFR reporting has increased demand for out-patient nephrology consultations and in some cases, prolonged queues. In Canada, a national task force suggested the development of waiting time targets, which has not been done for nephrology. We sought to describe waiting time for outpatient nephrology consultations in British Columbia (BC). Data collection occurred in 2 phases: 1) Baseline Description (Jan 18-28, 2010) and 2) Post Waiting Time Benchmark-Introduction (Jan 16-27, 2012). Waiting time was defined as the interval from receipt of referral letters to assessment. Using a modified Delphi process, Nephrologists and Family Physicians (FP) developed waiting time targets for commonly referred conditions through meetings and surveys. Rules were developed to weigh-in nephrologists', FPs', and patients' perspectives in order to generate waiting time benchmarks. Targets consider comorbidities, eGFR, BP and albuminuria. Referred conditions were assigned a priority score between 1-4. BC nephrologists were encouraged to centrally triage referrals to see the first available nephrologist. Waiting time benchmarks were simultaneously introduced to guide patient scheduling. A post-intervention waiting time evaluation was then repeated. In 2010 and 2012, 43/52 (83%) and 46/57 (81%) of BC nephrologists participated. Waiting time decreased from 98(IQR44,157) to 64(IQR21,120) days from 2010 to 2012 (p = <.001), despite no change in referral eGFR, demographics, nor number of office hrs/wk. Waiting time improved most for high priority patients. An integrated, Provincial initiative to measure wait times, develop waiting benchmarks, and engage physicians in active waiting time management associated with improved access to nephrologists in BC. Improvements in waiting time was most marked for the highest priority patients, which suggests that benchmarks had an influence on triaging behavior. Further research is needed to determine whether this effect is sustainable.
    Full-text · Article · Aug 2013 · BMC Nephrology
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    • "We assume that a difference in the score of two hours lost per two weeks due to presenteeism is a relevant difference. This is based on a recent study, where an average number of four lost hours per two weeks (SD: 3.9) was measured among patients with RA by using the WLQ [43]. A two hour per two weeks difference implies a moderate standardized effect of 0.5. "
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    ABSTRACT: Background Workers with rheumatoid arthritis (RA) often experience restrictions in functioning at work and participation in employment. Strategies to maintain work productivity exist, but these interventions do not involve the actual workplace. Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA. Methods/design This study is a randomized controlled trial (RCT) in specialized rheumatology treatment centers in or near Amsterdam, the Netherlands. Randomisation to either the control or the intervention group is performed at patient level. Both groups will receive care as usual by the rheumatologist, and patients in the intervention group will also take part in the intervention program. The intervention program consists of two components; integrated care, including a participatory workplace intervention. Integrated care involves a clinical occupational physician, who will act as care manager, to coordinate the care. The care manager has an intermediate role between clinical and occupational care. The participatory workplace intervention will be guided by an occupational therapist, and involves problem solving by the patient and the patients’ supervisor. The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work. Data collection will take place at baseline and after 6 and 12 months by means of a questionnaire. The primary outcome measure is work productivity, measured by hours lost from work due to presenteeism. Secondary outcome measures include sick leave, quality of life, pain and fatigue. Cost-effectiveness of the intervention program will be evaluated from the societal perspective. Discussion Usual care of primary and outpatient health services is not aimed at improving work productivity. Therefore it is desirable to develop interventions aimed at improving functioning at work. If the intervention program will be (cost)effective, substantial improvements in work productivity might be obtained among workers with RA at lower costs. Results are expected in 2015. Trial registration number NTR2886
    Full-text · Article · Jul 2012 · BMC Public Health
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    • "Results from LEAP suggested that weekly fluctuations in OA pain were associated with changes in levels of daily activities/functioning, work absenteeism, sleep interference, and healthcare resource use. In an analysis of four measures of presenteeism (the Health and Labor Questionnaire [HLQ]; the Work Limitations Questionnaire [WLQ]; the World Health Organization's Health and Work Performance Questionnaire [HPQ]; and the Work Productivity and Activity Impairment Questionnaire [WPAI]), Zhang et al. [28] observed a significant association between pain and the risk of presenteeism, but only weak associations between pain severity and hours lost. Another study implicated acute pain exacerbations as a factor in lost productivity in a population of employed adults with arthritis, however, the type of arthritis was not specified [13]. "
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    ABSTRACT: There has been increasing recognition that osteoarthritis (OA) affects younger individuals who are still participants in the workforce, but there are only limited data on the contribution of OA pain to work productivity and other outcomes in an employed population. This study evaluated the impact of OA pain on healthcare resource utilization, productivity and costs in employed individuals. Data were derived from the 2009 National Health and Wellness Survey. Univariable and multivariable analyses were used to characterize employed individuals (full-time, part-time, or self-employed) ≥ 20 years of age who were diagnosed with OA and had arthritis pain in the past month relative to employed individuals not diagnosed with OA or not experiencing arthritis pain in the past month. Work productivity was assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire; health status was assessed using the physical (PCS) and mental component summary (MCS) scores from the SF-12v2 Health Survey and SF-6D health utilities; and healthcare utilization was evaluated by type and number of resources within the past 6 months. Direct and indirect costs were estimated and compared between the two cohorts. Individuals with OA pain were less likely to be employed. Relative to workers without OA pain (n = 37,599), the OA pain cohort (n = 2,173) was significantly older (mean age 52.1 ± 11.5 years vs 41.4 ± 13.2 years; P < 0.0001) and with a greater proportion of females (58.2% vs 45.9%; P < 0.0001). OA pain resulted in greater work impairment than among workers without OA pain (34.4% versus 17.8%; P < 0.0001), and was primarily due to presenteeism (impaired activity while at work). Health status, assessed both by the SF-12v2 and the SF-6D was significantly poorer among workers with OA pain (P < 0.0001), and healthcare resource utilization was significantly higher (P < 0.0001) than workers without OA pain. Total costs were higher in the OA pain cohort ($15,047 versus $8,175; P < 0.0001), driven by indirect costs that accounted for approximately 75% of total costs. A substantial proportion of workers suffer from OA pain. After controlling for confounders, the impact of OA pain was significant, resulting in lower productivity and higher costs.
    Full-text · Article · Apr 2011 · BMC Musculoskeletal Disorders
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