Sickness Benefit Days Research Articles

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care

Purpose To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078–0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.

Decreasing time on sick leave for patients with heart failure in Sweden during two decades

Abstract Background Heart failure (HF) is increasing in people of working age in Sweden (1). Given high morbidity and reduced quality of life among HF patients (2, 3), working capacity could be greatly affected, however, studies are scarce. Purpose To determine trends in sick leave rates following a first hospitalization for HF in Sweden 1995–2015 compared to controls matched by age and sex. Methods In Sweden, people who cannot work receive sickness benefit. Sickness benefit pay days are registered by Statistics Sweden. We identified all patients aged 18–60 years with a first hospitalization for HF in Sweden 1995–2012 in the National Patient Register (NPR). For each case we selected 2 controls matched for age and sex. Cases and controls were split into age groups, &amp;lt;45 years and 45–60 years. Age, sex and comorbidities were recorded. Paid sickness benefit days were recorded during the index year and the two subsequent years. Results A total of 24,677 cases and 65,923 controls were included, mean age for the younger and older age group 36.6 and 54.5 years, and proportion of women 35.3% and 23.8%, respectively. In 1995, the proportion of time on sickness benefit in patients &amp;lt;45 years was on average 28%, decreasing to 15% in 2012, with corresponding estimates for patients 45–60 29% and 17%, shown by index year for cases and controls for patients &amp;lt;45 years in Figure 1 and for patients 45–60 years in Figure 2. Conclusion Patients had a longer time on sick leave than controls over the study period. Time on sickness benefit initially declined over the course of the study period for both patients and controls, but the last years of the study period this decline stalled for both patients and controls. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Swedish state under an agreement between the Swedish government and the County Councils Concerning Economic Support of Research and Education of Doctors [ALFGBG-717211, ALFGBG-433211, ALFGBG-725081]; the Swedish Heart and Lung Foundation [2013-0307, 2018-0419, 2018-0589]. Figure 1Figure 2

How common is change of primary diagnosis during an episode of sickness benefit? A register study of medical sickness certificates issued 2010-2012 in Sweden.

The aims of this study were to investigate how common it is to change primary diagnosis between different diagnostic chapters during a sick-leave spell, and to explore patterns of diagnostic changes. The unit for analysis was episode of sickness benefit, that is, sick leave >14 days, which commenced between 2010 and 2012 in Sweden. For each case, the primary diagnosis was retrieved from the first and last/latest medical sickness certificate, respectively. The number of days of sickness benefit was linked to the cases. Any change of primary diagnosis was analysed by diagnostic chapter according to the ICD-10, and this was done separately for women and men. In total, 803,041 cases of sickness benefit (63% women) were included in the study. During a sick-leave spell, 7.1% of female cases and 6.6% of male cases changed their primary diagnosis to a diagnosis from another diagnostic chapter. The change of primary diagnosis increased with the number of days with sickness benefit. For female cases, this increase was from 2.0% for cases that lasted 15-30 days to 20.2% for cases that lasted >365 days. For male cases, the corresponding increase was from 1.8% to 21.2%. A change of primary diagnosis was least common among those initially sick-listed for mental disorders and musculoskeletal disorders. The patterns of diagnostic changes were rather similar for women and men. A change of diagnosis during a sick-leave spell needs to be taken into consideration by the sickness insurance system and in the actions taken by its administration. Registry-based studies of sickness insurance need to consider diagnostic changes in both the study design and the interpretation of results.

Health in women on long-term sick leave because of pain or mental illness.

Mental illness and pain are common causes of long-term sick absence and major difficulties in vocational rehabilitation. The aim of this study was to investigate health in a group of women with pain or mental illness who had exhausted their days of sickness benefit. This cross-sectional study uses baseline data from 355 women on long-term sick leave participating in controlled intervention studies aiming at returning to work. The study population filled in a written questionnaire with questions of self-rated health and sleep quality and validated indexes of mental health, satisfaction with life and general self-efficacy. Clinical psychiatric screening was performed on 230 individuals. The study population had a mean age of 48.8 years (SD 8.4), with an average time on sick leave of 7.8 years (SD 3.2). Self-rated health and sleep quality was poor compared with other populations. In all, 80.1% had at least one psychiatric diagnosis according to the psychiatric screening, and the average numbers of psychiatric diagnoses were 2.2 (SD 1.9). Foreign-born women showed significantly higher levels of mental illness, poorer self-rated health and sleep quality and lower self-efficacy and life satisfaction than native Swedish women. Women with long sick leave because of mental illness and/or pain have poor self-rated health and sleep quality, high prevalence of mental illness and low self-efficacy and life satisfaction. Psychiatric screening suggests more extensive mental illness than what was stated on the sick leave certificates. The health of foreign-born women seems to be worse than that of native Swedish women.

OP0010 Reduced Sick Leave in Today’s Early RA Patients Compared to 10 Years Ago, the Swedish Tira Project

BackgroundTen years ago rheumatoid arthritis (RA) was associated to extensive sick leave during the years after diagnosis despite early instituted disease modifying anti rheumatic drugs (DMARD:s) (1). Since then the...

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial

BackgroundWithin the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care.Methods/DesignThe design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study.DiscussionFor sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System.Trial registrationTrial registration number: NTR1047.

Screening and intervention for alcohol-related disease in middle-aged men: the Malmö Preventive Programme.

In the Malmö Preventive Programme the tracing and prevention of alcohol-related disease was attempted by means of the enzyme serum gamma-glutamyltransferase (GGT) in a large unselected population of middle-aged men. Alcohol was considered to be the underlying factor in 70% of subjects with raised GGT values. In a prospective analysis, alcohol-related death turned out to be a major contributor to death in men who died within five years of the screening. GGT was the variable that was most predictive for premature death in this population. There were also statistically significant correlations between alcohol-related death and a questionnaire, the Mm-MAST, positively, and serum creatinine and serum cholesterol, negatively. In the randomized intervention programme, reductions in sickness benefit days, hospital admissions and mortality were seen in the intervention group in comparison with the control group, after four years of follow-up. The intervention programme was therefore effective in preventing the consequences of heavy drinking, and a risk factor approach to alcohol-related diseases seems feasible. This approach, however, encounters several problems, such as the recruitment of the non-participants in the screening, the investigation of the GGT-high/non-alcoholic subjects, and the identification of the GGT-normal/alcoholic subjects.

The indirect costs of morbidity in type II diabetic patients.

In an attempt to obtain an appropriate estimate of the excess costs of production losses arising from morbidity in patients with diabetes, we compared the number of sick days and permanently disabled individuals in a diabetic population and the corresponding general population. These comparisons show that the rate of premature retirement for both insulin-dependent diabetes mellitus (IDDM, type I diabetes) or non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) patients was twice that of the average population. Insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people aged 20 to 64 years with type II diabetes were about $US7000 per individual and year. Most of these excess costs were attributed to permanent disability in the 40- to 64-year age groups.

Sickness Absenteeism and Mortality in Patients with excessive Drinking in Somatic Out-patient Care

In a study of 2114 patients attending somatic outpatient clinics, 208 were classified as excessive drinkers. Sickness benefit days and sickness periods per year, disability pension, and mortality were studied for the years 1981 to 1985. The excessive drinkers as a group had 13 to 27 more sickness days per year than the other patients. They also had more sickness periods and a higher rate of disability pension than patients without alcohol overconsumption. The study thus showed that a group with varying degrees of excessive drinking had an increased need for sickness benefits. The mortality was considerably increased among the excessive drinkers. The patients who had undergone treatment or were registered because of alcohol problems had most sickness benefit days. The excessive drinking patients without advanced alcohol problems did not have more sickness days than the other patients. Most of these patients (75%) were sick-listed without recognition of their excessive drinking by their doctor. This emphasizes the importance, in terms of sickness benefits and mortality, of better identification of patients with excessive drinking.

Characteristics of males with myocardial infarction below age 40

All cases of initial myocardial infarctions (MI) diagnosed among men below age 40 in Göteborg during 1970–1977 have been studied. The cases have been compared with a random sample from the general population in Göteborg with respect to socio-economic factors and conventional risk factors. The MI-cases showed a special socio-economic pattern prior to the infarction and were more often single and of foreign origin, had more previous sickness benefit days and were more often registered for alcohol abuse than contemporaries in the general population. Moreover, the surviving MI-cases were found to be heavily burdened with the conventional risk factors smoking, cholesterolemia and high blood pressure.

Bias due to non-participation and heterogenous sub-groups in population surveys

A random sample of men in the age-group 30–39 years from the general population in Göteborg, Sweden, has been investigated with respect to socioeconomic factors and risk factors for coronary artery disease. The total sample could well be characterized with socioeconomic variables obtained from public registers. All the individuals of the sample were invited to an examination which 68% attended (participants). It was found that those not attending the examination (non-participants) greatly differed from the participants. The non-participants were more often unmarried, and had lower annual incomes and more sickness benefit days. There were more foreigners and more individuals registered for intemperance among the non-participants than the participants. Among the participants the foreigners reported lower physical activity and had higher serum cholesterol than the participating Swedes and individuals registered for intemperance stated a higher tobacco consumption and had higher systolic and diastolic blood pressures than those not registered. This highlights that consideration of factors discriminating participants and non-participants is important for proper estimation of population parameters. The same is true for comparisons between cases and controls recruited from cross-sectional population surveys.

Health insurance records in the course of alcoholism. A two-year follow-up study.

The Health Insurance Records of 32 male alcoholics were related to outcome after 2 years, with regard to drinking habits, self-esteem, social stability and Temperance Board registrations. The numbers of sickness benefit days were found significantly related to drinking habits (p less than 0.05), self esteem (p less than 0.01), social stability (p less than 0.01) and Temperance Board registrations (p less than 0.001). These levels of significance were generally higher than those between the outcome variables themselves. The number of sickness benefit days was superior to the incidence of sickness in describing the clinical course. Categorization according to the diagnoses did not increase the strength of the relationships with outcome variables. The number of sickness benefit days during the 5-year period prior to the first examination was significantly related to Temperance Board registrations (p less than 0.01) and social stability (p less than 0.05) during the follow-up period but not to drinking habits or self-esteem. No relationship was found between the number of sickness benefit days during this 5-year period and the follow-up period. It is concluded that Health Insurance Records are of use in follow-up studies on alcoholics.

Disability of psychiatric patients

In Sweden, all inhabitants over 16 years of age are covered by compulsory insurance and registered by the public insurance funds. Earlier investigations of Swedish National Health Insurance materials have shown that mental disorder is a common cause of disability pension and long term sickness benefit. The purpose of the present study was to estimate the magnitude of disability in persons with a history of psychiatric contact. — The material consisted of a geographically defined subsample of a randomized series of psychiatric patients. The local National Health Insurance records were used for estimating the rate of sickness. The amount of sickness benefit given to 194 patients (74 men and 120 women) treated at a department of psychiatry in 1962 was studied during the subsequent four years. Controls matched for sex, age and domicile were obtained from the local branches of the National Health Insurance Service. Disability pension was granted to 9 men and 15 women in the patient group, and to 4 men and 1 women in the control group. The average number of sickness benefit days per year was 4.9 times larger for male patients and 3.4 times larger for female patients, than for the corresponding controls. The higher sickness reporting in men was due to both psychiatric and physical illness. In women only sickness reporting because of psychiatric illness was significantly increased.