Multimorbidity and fit note receipt in working-age adults with long-term health conditions

Abstract Background Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. Methods Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. Results We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73–12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60–4.87), chronic pain and depression (HR 4.14; 95% CI 3.69–4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36–4.95). Conclusions Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.

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Perceptions of safety and exposure to violence in public places among working age adults with disabilities or long-term health conditions in the UK: cross sectional study

Public Health ◽

10.1016/j.puhe.2015.10.036 ◽

2016 ◽

Vol 135 ◽

pp. 91-96 ◽

Cited By ~ 5

Author(s):

E. Emerson ◽

L. Krnjacki ◽

G. Llewellyn ◽

C. Vaughan ◽

A. Kavanagh

Keyword(s):

Exposure To Violence ◽

Cross Sectional Study ◽

Health Conditions ◽

Sectional Study ◽

Cross Sectional ◽

Public Places ◽

Working Age ◽

Perceptions Of Safety ◽

The Uk

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Health conditions, disability and economic inactivity in Northern Ireland. An administrative data study.

International Journal for Population Data Science ◽

10.23889/ijpds.v4i3.1189 ◽

2019 ◽

Vol 4 (3) ◽

Author(s):

Ana Corina Miller ◽

Dermot O’Reilly ◽

David Wright ◽

Foteini Tseliou ◽

Michael Rosato ◽

...

Keyword(s):

Mental Health ◽

Northern Ireland ◽

Labour Market ◽

Health Condition ◽

Health Conditions ◽

Mental Health Conditions ◽

Active Population ◽

Working Age ◽

The Uk

Background Northern Ireland consistently experiences a higher rate of economic inactivity compared to other regions of the UK, currently 27% of the working age population compared to 22% in the UK. Historically, the major variance in explaining higher NI economic inactivity rates has been larger proportions of long-term sick/disabled. Only 34.7% of the NI population with a disability are employed compared to 77.9% of the non-disabled population. Aim The aims were to explore the relationship between chronic health status and the labour-market in NI, and how receipt of DLA is associated with economic inactivity. Methods This study links the 2011-NI-Census records, DLA-dataset, death registrations for the Census population, settlement-band data, the Land and Property Service capital-valuation of property, and the NI-Multiple-Deprivation Measure. The economically active population was defined as all individuals that were either employed or unemployed but looking for a job at the time of the 2011-Census. Results Men with mental-health conditions reporting a lot of limitation in day-to-day activities are almost 51 times more likely to be economically inactive compared to men with no health condition (ORadj=50.99, 95%CI:46.8,55.6). Learning/mental-health conditions are more likely to be associated with economic inactivity in both women and men compared to physical health conditions, such as long-term pain, mobility or breathing difficulties. Individuals in receipt of DLA are more than twice as likely to be economically inactive as their peers who are not in receipt of DLA. Conclusion Individuals with mental-health conditions reporting a lot of limitation in day-to-day activities have the lowest rates of participation in the labour-market. A lot of limitation in the day-to-day activities appears to be strongly associated with economic inactivity regardless of the health condition. DLA uptake is associated with considerably reduced likelihood of being economically active overall while the health conditions underlying DLA uptake are strong barriers to access the labour-market in NI.

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

BMJ Open ◽

10.1136/bmjopen-2018-024980 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024980 ◽

Cited By ~ 2

Author(s):

Tiia T M Reho ◽

Salla A Atkins ◽

Nina Talola ◽

Markku P T Sumanen ◽

Mervi Viljamaa ◽

...

Keyword(s):

Primary Care ◽

Longitudinal Study ◽

Occupational Health ◽

Sick Leave ◽

Diagnostic Codes ◽

Frequent Attenders ◽

Frequent Attendance ◽

Increased Risk ◽

Working Age

ObjectivesFrequent 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 participantsThis 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).ResultsBoth 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.ConclusionBoth 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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Physicians’ experiences with sickness absence certification in Finland

Scandinavian Journal of Public Health ◽

10.1177/1403494818758817 ◽

2018 ◽

Vol 47 (8) ◽

pp. 859-866 ◽

Cited By ~ 3

Author(s):

Katariina Hinkka ◽

Mikko Niemelä ◽

Ilona Autti-Rämö ◽

Heikki Palomäki

Keyword(s):

Sickness Absence ◽

Social Insurance ◽

Waiting Times ◽

Practice Setting ◽

Sickness Certification ◽

National Guidelines ◽

Know How ◽

Rehabilitation System ◽

Clinical Practice Setting ◽

Working Age

Aims: The aim of this study was to explore Finnish physicians’ perceptions of sickness absence (SA) certification. Methods: A questionnaire was sent to 50% of the physicians in Finland who provide care to working-age patients in a clinical practice setting. Of the 8867 physicians, 3089 responded. Physicians handling SA certification patients at least a few times per month were included ( n = 2472). Results: At least a few times per month, 61% of all physicians perceived SA issues as problematic, 60% had experienced a lack of time in dealing with SA matters, 36% had disagreed with a patient on SA certification, and 36% had met a patient who wanted a SA certificate for reasons other than a disease or injury. Physicians were least worried about patients filing complaints (4%), exhibiting threatening behaviour (2%), or switching physicians for SA certification reasons (1%). A total of 60% of physicians had prescribed SA for a longer period than necessary because of long waiting times for further care/measures. Non-specialized physicians, general practitioners, and psychiatrists experienced problems more frequently than surgeons and occupational health physicians. Over 50% of the respondents had a fairly large or very large need to deepen their knowledge of social insurance matters. The need for national guidelines for all or some diseases was reported by 80% of the respondents. Conclusions: Many physicians perceive SA tasks as problematic and are unable to dedicate enough time to them. Shortcomings in physicians’ sickness certification know-how, as well as obstacles in the healthcare and rehabilitation system, prolong the SA process. Attitudes towards the adoption of national guidelines on the duration of SA were positive.

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Does workplace social capital protect against long-term sickness absence? Linking workplace aggregated social capital to sickness absence registry data

Scandinavian Journal of Public Health ◽

10.1177/1403494817721672 ◽

2017 ◽

Vol 46 (3) ◽

pp. 290-296 ◽

Cited By ~ 9

Author(s):

Anne-Sophie K. Hansen ◽

Ida E. H. Madsen ◽

Sannie Vester Thorsen ◽

Ole Melkevik ◽

Jakob Bue Bjørner ◽

...

Keyword(s):

Social Capital ◽

Private Sector ◽

Sickness Absence ◽

Collective Good ◽

Standard Deviation Increase ◽

Individual Level ◽

The Individual ◽

Adjusted Model ◽

Workplace Social Capital

Aims: Most previous prospective studies have examined workplace social capital as a resource of the individual. However, literature suggests that social capital is a collective good. In the present study we examined whether a high level of workplace aggregated social capital (WASC) predicts a decreased risk of individual-level long-term sickness absence (LTSA) in Danish private sector employees. Methods: A sample of 2043 employees (aged 18–64 years, 38.5% women) from 260 Danish private-sector companies filled in a questionnaire on workplace social capital and covariates. WASC was calculated by assigning the company-averaged social capital score to all employees of each company. We derived LTSA, defined as sickness absence of more than three weeks, from a national register. We examined if WASC predicted employee LTSA using multilevel survival analyses, while excluding participants with LTSA in the three months preceding baseline. Results: We found no statistically significant association in any of the analyses. The hazard ratio for LTSA in the fully adjusted model was 0.93 (95% CI 0.77–1.13) per one standard deviation increase in WASC. When using WASC as a categorical exposure we found a statistically non-significant tendency towards a decreased risk of LTSA in employees with medium WASC (fully adjusted model: HR 0.78 (95% CI 0.48–1.27)). Post hoc analyses with workplace social capital as a resource of the individual showed similar results. Conclusions: WASC did not predict LTSA in this sample of Danish private-sector employees.

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The context of healthcare

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0001 ◽

2020 ◽

pp. 1-34

Keyword(s):

Public Health ◽

Primary Care ◽

Northern Ireland ◽

Healthcare Services ◽

Health Profile ◽

Long Term Conditions ◽

Key Concepts ◽

The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

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Using Technology to Empower People With Multiple Sclerosis (MS) to Make Shared Decisions About Managing Their Own Healthcare

Advances in Medical Technologies and Clinical Practice - Impacts of Information Technology on Patient Care and Empowerment ◽

10.4018/978-1-7998-0047-7.ch010 ◽

2020 ◽

pp. 177-198

Author(s):

Helen King ◽

Darina M. Slattery

Keyword(s):

Multiple Sclerosis ◽

National Health Service ◽

Health Information ◽

Digital Health ◽

Health Conditions ◽

Digital Information ◽

Uk National Health Service ◽

The Uk ◽

Information Providers

In 2014, the UK National Health Service (NHS) ‘Five Year Forward View' plan set out key objectives to reform the NHS, which included empowering the population as a whole (particularly those with long-term health conditions) to take more responsibility for managing their own healthcare and introducing initiatives to use technology to improve services and reduce costs. The “Long Term Plan” explains how the 2014 initiatives will be further developed. This chapter presents a review of literature on digital health information and information usability. It presents the key findings from a mixed methods study that explored how people with MS (PwMS) access and use health digital information when trying to manage their MS. While the study found that there is much good quality digital health information available for PwMS, and that this facilitates shared decisions, some necessary information is still missing. The chapter concludes with recommendations for digital health information providers.

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Education differences in sickness absence and the role of health behaviors: a prospective twin study

BMC Public Health ◽

10.1186/s12889-020-09741-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

K. B. Seglem ◽

R. Ørstavik ◽

F. A. Torvik ◽

E. Røysamb ◽

M. Vollrath

Keyword(s):

Health Behaviors ◽

Educational Attainment ◽

Sickness Absence ◽

Causal Effect ◽

Familial Factors ◽

Individual Level ◽

Cohort Differences ◽

Genes And Environment

Abstract Background Long-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account. Methods Participants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins’ educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding. Results Low education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort. Conclusions The associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

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