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Working Health Services Scotland: a 4-year evaluation

Working Health Services Scotland: a 4-year evaluation Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 Occupational Medicine 2018;68:38–45 Advance Access publication 30 January 2018 doi:10.1093/occmed/kqx186 Working Health Services Scotland: a 4-year evaluation 1,2 3 2 4 2 E. Demou , M. Hanson , A. Bakhshi , M. Kennedy and E. B. Macdonald MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow G2 3QB, UK, Healthy Working Lives Group, Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, 3 4 UK, WorksOut, The Green House, Edinburgh EH4 1NR, UK, Salus Occupational Health, Safety & Return to Work Services, Hamilton ML3 0TA, UK. Correspondence to: E. Demou, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow G2 3QB, UK. Tel: +44 (0)141 353 7580; fax: +44 (0)141 332 0725; e-mail: evangelia.demou@ glasgow.ac.uk Background Working Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it. Aims To evaluate the impact on health and work outcomes of WHSS clients over a 4-year period. Methods Data were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge—EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM). Results A total of 13 463 referrals occurred in the 4-year period; 11 748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health condi- tions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up. Conclusions The WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers. Key words Case management; intervention; mental health; musculoskeletal disorders; return-to-work; sickness absence; SME. SA interventions. Although only responsible for a small Introduction percentage of SA events, long-term SA events account Sickness absence (SA) is a public health issue with sub- for ~75% of absence costs [2,6]. Workplace interven- stantial impacts on employers, employees, health care tions targeted at improving physical and psychosocial systems and society [1–3]. The longer someone is ab- health [7–9], quality of life [10], emotional well-being sent, the higher the risk of not returning to work [3]. As [11], presenteeism [11], absenteeism [12] and SA [13] SA is multicausal, the biopsychosocial (BPS) model has are effective. The workplace is often a conducive environ- been used in the management of SA [4] and is recog- ment to implement programmes and practices to pro- nized by the World Health Organization (WHO) [5] as mote employee health and well-being [14]. an appropriate model. Employees of small and medium-sized enterprises Mental health (MH) and musculoskeletal disorders (SMEs) and the self-employed are most likely to have (MSD) are the leading cause of long-term SA [1,2]. little or no formal occupational health (OH) support These are of particular interest because improving [15]. A  study on the health and well-being needs of return-to-work (RTW) times is one of the main goals of SME employees found SA and presenteeism to be two © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 39 emerging themes [14]. The characteristics, working pat- questionnaire (EQ-5D) and visual analogue scale (EQ- terns and culture in SMEs further impact on absentee- 5D VAS), the Hospital Anxiety and Depression Scale ism and presenteeism rates [16]. The size of the SME, (HADS) and the Canadian Occupational Performance and their knowledge of OH and its importance, influence Measure (COPM). EQ-5D was included in the 3- and provision of OH services in SMEs [17]. A  large num- 6-month follow-up [8]. ber of SMEs understand and monitor SA and its impact Clients completed telephone assessments to establish on their organization [17], whereas only a small frac- eligibility and provide consent, followed by a telephone tion undertake health promotion activities [15]. SME- assessment by the case manager [18]. Where required, specific information about the occurrence of SA and clients were referred to services either within or external work attendance behaviour when dealing with a health to WHSS (appointments within 5–10 working days from issue and the variables that influence these decisions is referral). Case managers monitored progress and clients needed for the development of tailored interventions for were discharged when suitable improvements in health/ this sector [16]. work ability were achieved or if WHSS was no longer The Working Health Service Scotland (WHSS) pro- supporting them adequately. Discharged clients were fol- gramme, funded by the Scottish Government and UK lowed up 3 and 6 months post-discharge. Department for Work and Pensions (DWP), was devel- Descriptive statistics analysed demographics, health oped to help meet this need within SMEs [18]. It pro- condition, and health assessment scores pre-/post-inter- vides telephone-based case management and some vention and at follow-up. Univariate analysis was used face-to-face therapeutic support to SME employees to investigate differences pre-/post-intervention. A  gen- whose health condition affects their ability to work [19]. eral linear model was used to examine significant pre- WHSS aims to provide support for health conditions dictors of the degree of change in the health assessment which may impact on the clients’ work and/or other areas scores. Multivariate statistical analysis was used to inves- of their lives, to allow them to RTW (if absent) or remain tigate the relationships between the routinely collected in work (if not absent). variables and explore which predictor variables were The service is provided in 11 health board areas in associated with the outcome variable(s). Predictor vari- Scotland (out of 14), with clients from outside these areas ables included age, gender, deprivation (Scottish Index being managed by other boards [18]. The self-employed of Multiple Deprivation, SIMD), health condition and and SME (<250 employees) employees in Scotland can work status. For clients who completed WHSS, number self-refer, or be referred by a general practitioner (GP) or of therapeutic sessions attended, programme duration allied health professional (AHP); employers cannot make and therapies received were also predictor variables. The referrals. WHSS uses a BPS approach with an occupa- outcome variable was programme completion (dichot- tional focus and provides physiotherapy, occupational omous: completed/discharged); and for those who com- therapy and psychological therapy/counselling where pleted the difference in pre- and post-intervention health appropriate. Care is coordinated by a case manager. assessment scores was investigated. In a second analysis, This study aimed to investigate the health and work/ the outcome was work status (dichotomous: in work/ab- functional outcomes of WHSS clients referred between sent) at time of exit from WHSS. 2010 and 2014 and understand the factors associated This is a retrospective study using secondar y anonymized with programme completion and RTW. data. Ethical approval was not required as confirmed by the NHS Lanarkshire Research & Development Manager. Methods Results Client data enrolled between 26 March 2010 and 31 March 2014 (including discharge data to 28 July A total of 13 463 referrals were made over the study period, 2014)  were analysed [18]. Data collection points included: with 11 748 cases (87%) eligible with completed entry enrolment (WHSS eligibility assessment, i.e. working for assessments. Some individuals entered the programme a Scottish SME); entry (first telephone assessment by more than once, so the number of unique individuals (i.e. case manager—‘pre-intervention’); therapy provision (ser- ‘clients’) is less than the number of referrals (i.e. ‘cases’). vices received); discharge (discharge from WHSS—‘post- The majority (92%) of referrals were new referrals; 5% intervention’); 3-month post-discharge follow-up (recording were re-referring with a new health condition; and 3% health measures, work ability and absence status); and were re-referring with the initial health condition. The 6-month post-discharge follow-up (repeat of data gathered analysis hereafter is based on the number of ‘cases’ and not at 3-month follow-up). Demographic, health (present- ‘clients’, so each individual referral is considered unique. ing conditions) and employment status (at work/absent) Overall 7% of females and 6% of males re-entered WHSS, data were collected at entry. Clients also completed with older clients more likely to re-enter [18]. up to three standard, validated health questionnaires The number of cases significantly increased with at entry and discharge—the EuroQol five dimensions increasing SIMD category (P  <  0.01) (Table  1). Most Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 40 OCCUPATIONAL MEDICINE Table 1. Demographic details at entry by SIMD quintiles Cases pre-intervention SIMD quintiles Whole sample 1 (most deprived) 2 3 4 5 (least deprived) Number 1718 2228 2467 2626 2709 11 748 Average age (SD) (years) 43.3 (12) 43.5 (12) 44.6 (12) 45.7 (12) 45.4 (12) 44.6 (12) Gender Female (%) 49 47 49 48 48 48 Male (%) 50 52 50 51 51 51 Missing/not specified (%) 0.4 0.8 0.5 0.7 0.8 0.6 Primary health condition MSD (%) 85 83 83 85 85 84 MH (%) 12 14 13 11 11 12 Other (%) 3 3 4 4 4 4 Employment status Full-time (%) 74 77 75 78 75 76 Part-time (%) 26 23 25 22 25 24 Absent at entry (%) 24 22 22 21 19 21 demographic data were relatively similar across SIMD information on absence duration prior to entry to WHSS, quintiles, with the exception of age and absence status at with 36% absent for <2 weeks and 20% absent for >12 entry (Table 1). The greatest proportion of cases (21%) weeks (Figure S1, available as Supplementary data at came from the standard occupational classification Occupational Medicine Online). (SOC) group SOC-5: skilled trades occupations, while Forty-one per cent of cases who entered the pro- the smallest (7%) came from SOC-8: process, plant gramme did not complete the discharge paperwork. This and machine, and SOC-9: elemental occupations. The analysis is based on the data received from those who majority of cases were referred with a MSD (84%); while completed at least some of the discharge paperwork. 12% were referred with a MH condition. All other health The average time in WHSS was 121  ±  81  days (Table conditions were categorized as ‘Other’ (4%). This paper S2, available as Supplementary data at Occupational focuses on MSD and MH cases. Medicine Online). Overall, half (50%) of the 11 103 There was a significant association between depriv- cases, for whom there were entry EQ-5D scores, com- ation (SIMD) and primary condition (P  < 0.05); cases pleted the discharge EQ-5D. Socio-demographic char- in SIMD 2 and 3 were 1.2 and 1.1 times more likely, re- acteristics between those that completed the programme spectively, to have MH as their primary condition com- were similar to the entire WHSS population for gender, pared to the least deprived (SIMD 5). There was also a primary health condition, SIMD and absence status at strong association between gender and primary condi- entry. Multivariate analysis showed that age was a signifi- tion (P  <  0.01), with women twice as likely as men to cant predictor of completion (P  <  0.001) and number present with a MH condition (relative risk [RR] = 2.00; of services and longer duration in WHSS were inversely 95% CI: 1.81 to 2.22). Type of occupation was also associated with the odds of completing discharge paper- associated with primary condition (P  <  0.01); all oc- work (P < 0.001) [18]. cupational groups had a higher risk of MH conditions The majority of cases (75%) were at work at entry and compared to SOC-5, with the associate professional and discharge, while 4% were absent at entry and discharge. technical occupations group (SOC-3) having the highest However, 18% (n = 1188) who were absent at entry were risk overall (three times higher risk of MH conditions at work at discharge. Two per cent were at work at entry compared to SOC-5). and absent at discharge. Cases more likely to be absent at A secondary health condition was reported by 2154 discharge included cases: in the most deprived compared cases (16%); 24% of MH cases had a secondary health to least deprived group (RR  =  1.89; 95% CI: 1.42 to condition (most commonly another MH condition), 2.53); aged over 50 compared to 30–39 years old group while 15% of MSD cases had a secondary condition (RR = 1.44; 95% CI: 1.09 to 1.92); with MH rather than (most commonly another MSD) (Table S1, available as MSD conditions (RR  =  1.89; 95% CI: 1.50 to 2.39); Supplementary data at Occupational Medicine Online). and cases absent at entry were six times more likely to be A quarter of cases (n  =  2902) were absent at entry. absent at discharge compared to those at work at entry By primary health condition, 21% (n = 2121) of MSD (RR = 6.04; 95% CI: 5.00 to 7.30). cases and almost double (41%; n  =  589) of MH cases Number of working days lost since entering WHSS were absent at entry. A  total of 2145 cases provided was available for 649 cases. Overall, 50% were back to Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 41 work in 27 days (95% CI: 25 to 29) (Figure 1a). Number durations; for every 10 additional days in the programme, of days lost was significantly higher in MH than MSD 2 days of SA were added. cases (P < 0.001); 50% of MH and MSD cases returned All health measures recorded a statistically signifi- to work in 46 and 21 days, respectively. Number of days cant beneficial change between entry and discharge lost was also significantly higher for cases absent longer (P  <  0.001) (Table  3); the change in HADS scores for prior to entering WHSS (P < 0.001). MH cases was greater than for MSD cases, while the The best-fit model for SA duration (Table 2) included changes in the other measures were more similar when age, length of absence before entering WHSS, primary comparing by health condition. condition and discharge time. Gender, SIMD, occupa- In total, 88% (n  =  4920) of cases improved their tion and general health status at entry were not signifi- EQ-5D index score by an average of 0.35 (P  <  0.001). cant. Age added almost 5 days to SA duration while in By primary health condition, 89% of MSD and 84% of the programme for every 10-year age category. Moving MH cases improved their EQ-5D score, with a slightly up in SA duration prior to entry categories, 10 days were greater increase for MSD cases (Figure S2a, available as added to SA duration while in the programme. Duration Supplementary data at Occupational Medicine Online). of SA reduced by 10  days for cases presenting with By absence status at entry (Figure S2b, available as MSD compared to MH conditions. Longer SA periods Supplementary data at Occupational Medicine Online), while in WHSS were associated with longer programme 88% of those at work (n = 4267) and 88% of those absent Figure 1. Survival analysis; (a) Kaplan–Meier RTW curve for all: number of days lost due to SA (solid line) with 95% CI (dotted line; N = 649); (b) Kaplan–Meier RTW curve by primary condition (MH = mental health cases; MSD = musculoskeletal cases); and (c) median length of time (days) being absent since entry assessment by the number of weeks absent before entry assessment. Table 2. Model result of ARIMA model for duration of SA of referrals Model parameters Estimate (days) Standard error of estimates Z-statistic P-value Age (years) 0.49 0.16 3.04 <0.01 Duration of SA prior to entering the programme (ref = 0–2 9.91 1.81 5.47 <0.001 weeks) Primary condition (ref = MH) −10.60 3.65 2.90 <0.01 Discharge time (days) 0.22 0.03 8.23 <0.001 SA duration prior to entry assessment was re-coded for the analysis (1 = 0 to 2 weeks; 2 = 3 to 5 weeks; 3 = 6 to 8 weeks; 4 = 9 to 11 weeks; 5 = over 12 weeks). Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 42 OCCUPATIONAL MEDICINE Table 3. Average changes in health measure scores Measure Pre-intervention Post-intervention Average change in Number 95% CI mean score mean score score EQ-5D index All completers 0.51 0.81 0.30 5590 [0.29 to 0.31] MSD cases 0.50 0.81 0.31 4749 [0.29 to 0.31] MH cases 0.58 0.84 0.26 646 [0.26 to 0.29] EQ-5D VAS score All completers 59.1 80.0 22.5 5472 [22.49 to 22.50] MSD cases 60.6 80.8 22.5 4653 [22.49 to 22.50] MH cases 48.8 76.2 30.0 631 [27.50 to 30.00] COPM Performance score All completers 3.84 7.54 3.70 3771 [3.99 to 4.00] MSD cases 3.91 7.62 3.71 3182 [4.00 to 4.04] MH cases 3.27 7.26 3.99 457 [4.00 to 4.50] COPM Satisfaction score All completers 2.87 7.44 5.00 3754 [4.99 to 5.00] MSD cases 2.91 7.53 5.00 3166 [5.00 to 5.17] MH cases 2.46 7.18 5.00 457 [4.75 to 5.25] HADS anxiety score All completers 7.36 4.04 −3.32 1696 [−4.00 to −3.50] MSD cases 5.57 3.26 −2.31 1203 [−3.00 to −2.50] MH cases 12.67 6.18 −6.50 400 [−7.50 to −6.50] HADS depression score All completers 5.94 2.80 −3.14 1696 [−3.50 to −3.00] MSD cases 4.68 2.33 −2.35 1203 [−3.00 to −2.50] MH cases 9.65 3.98 −5.67 400 [−6.50 to −5.50] COPM Performance and Satisfaction scores range from 0 to 10; a higher score represents better performance, and better satisfaction. HADS scores range from 0 to 21, while 0–7 is considered ‘normal’, 8–10 ‘borderline’ and 11–21 is ‘caseness’. Note also that a negative change in score for the HADS anxiety and depression scores indicates an improvement. (n = 1323) improved their EQ-5D score, by 0.28 and 0.35, improved by an average of 4.1, n  =  1203). The change respectively. Similarly, 81% improved their EQ-5D VAS in scores was also greater for those absent at entry scores by an average score of 27.8 points (P < 0.001). Of (80% improved by an average of 5.9, n  =  490) com- those who improved their score MH cases demonstrated a pared with those at work (70% improved by an aver- 6-point greater change compared with MSD cases (Figure age of 4.7, n = 1206) (Table S3d and S3e, available as S2c, available as Supplementary data at Occupational Supplementary data at Occupational Medicine Online). Medicine Online). Mean VAS score was higher both at A ‘caseness’ status for depression was reported by entry and discharge for MSD compared with MH cases 18% at entry and dropped to 5% at discharge (Table (Table 3). By absence status at entry (Figure S2d, available S4a, available as Supplementary data at Occupational as Supplementary data at Occupational Medicine Online), Medicine Online). A total of 455 (27%) cases transitioned a greater proportion of those who were absent at entry to a healthier category, with 12% transitioning from the improved their VAS score, than those who were at work. worst category ‘caseness’ to ‘normal’. Improvement in HADS scores show nearly one-third of cases (29%) scores was greater for MH (85% improved by an aver- had ‘caseness’ anxiety status at entry, changing to just age of 7%, n = 400) compared with MSD cases (66% 8% at discharge (Table S3a, available as Supplementary improved by an average of 4.0, n = 1203) (Table S4b and data at Occupational Medicine Online). In total, 574 S4c, available as Supplementary data at Occupational cases (34%) transitioned to healthier anxiety catego- Medicine Online). The change in scores was also greater ries, with 17% transitioning from the worst state ‘case- for those absent at entry (79% improved by an aver- ness’ to normal (Table S3a, available as Supplementary age of 6.1, n = 490) compared with those at work (69% data at Occupational Medicine Online). By primary improved by an average of 4.3, n = 1206) (Table S4d and health condition, 23% of MSD (Table S3b, avail- S4e, available as Supplementary data at Occupational able as Supplementary data at Occupational Medicine Medicine Online). Online) and 69% of MH cases (Table S3c, available as COPM Performance scores increased for 89% of Supplementary data at Occupational Medicine Online) cases (n = 3771) by 4.2 points on average. Improvements moved to a healthier anxiety state. Improvement in were similar for both MSD and MH cases (Figure S3a, scores was greater for MH (89% improved by an aver- available as Supplementary data at Occupational Medicine age of 8%, n = 400) compared with MSD cases (67% Online); and greater for those absent at entry than those Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 43 at work at entry (Figure S3b, available as Supplementary An important finding was the relationship between data at Occupational Medicine Online). age and SA duration, with there being on average Similarly, 90% of cases improved their COPM five more days of absence for every 10  years of age. Satisfaction score (n  =  3754) by 5.1 on average. Older workers may have longer SA, although gener- Improvements were similar for both MSD and MH ally have fewer SA episodes [20]. This finding indi- cases (Figure S3c, available as Supplementary data at cates the need for improved OH and routine care for Occupational Medicine Online); and greater for those older workers. absent at entry than those at work at entry (Figure S3d, The majority of cases in WHSS had an MSD (84%), available as Supplementary data at Occupational Medicine which does not appear to reflect the fact that common MH Online). disorders are a leading cause of SA [21]. This may suggest Altogether 2033 cases provided EQ-5D follow-up that a significant proportion of the workforce experienc- data at ~3  months, 6  months, or both 3 and 6  months ing a MH condition may not be accessing this service. after discharge and these figures demonstrate a sus- Ways of addressing this should be considered in any future tained improvement in EQ-5D scores at 3 and 6 months programmes. Health improvements and RTW outcomes (Figure 2). were generally better for MH than MSD cases, although they generally entered the programme with worse health scores and longer absence durations prior to entry. Discussion The uniqueness and richness of this data set, covering All health measures showed significant improvements an often hard-to-reach population—i.e. SME employees from entry to discharge in health and functional ability; with health issues—are significant study strengths. Using the majority of WHSS cases experienced health benefits. secondary routine data, we analysed changes in health, COPM scores significantly improved in 90% of cases, well-being and work ability pre-/post-intervention. The evidencing positive impacts on functional capacity and study included a large sample, a large number of socio- coping. The 3- and 6-month follow-ups provide evidence demographic variables and the use of up to three stand- of the sustainability of the health improvements seen at ardized health/function assessment tools. Cases broadly discharge, and of cases remaining in work and working represented the demographics of Scottish workers in normal working hours after leaving WHSS. terms of gender [22], while the service supported more An integral part of the case management process older workers (>50 years) than the proportion reflected was to identify co-morbidities, which were present in in Scottish employment statistics [22]. This is important 24% and 15% of cases with MH and MSD conditions, given that older workers may have greater needs for such respectively. Identifying these co-morbidities will have services in light of policies to extend working lives. The helped case managers to provide more holistic care. study covered the two leading causes of SA and work This is evident in the HADS scores of individuals with incapacity [6]. This highlights the need for services sup- MSD primary conditions where there was a 23% and porting those with MSD and MH conditions affecting 17% reduction of anxiety and depression symptoms, work ability. respectively. Co-morbidities are not always recognized in As is the case in many service evaluations, the lack routine care but are likely to influence clinical and func- of a control population is the main study limitation. tional outcomes. Discharge data were only available for 60% of eligible Figure 2. EQ-5D index score for entry, discharge, 3 and 6 months post-discharge. Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 44 OCCUPATIONAL MEDICINE cases, primarily due to not being able to contact the non- Gibson, Patsy Cavanagh and Cathy Evans for their helpful dis- cussions regarding WHSS and the evaluation. completers (60% of non-completers), or their voluntary withdrawal (15%). While the results demonstrate an improvement in health status that was sustained at 3 and Conflicts of interest 6 months post-discharge and an overall improvement in None declared. work status, the lack of a control means the effectiveness of WHSS cannot be assessed, as it is not possible to meas- References ure the health and employment outcomes for individuals who did not receive this service, and those who did not 1. Ritchie KA, Macdonald EB, Gilmour WH, Murray KJ. complete it. 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Health and Safety Psychological distress, related work attendance, and pro- Implications. 2013. https://www.unison.org.uk/content/ ductivity loss in small-to-medium enterprise owner/man- uploads/2013/06/On-line-Catalogue214743.pdf (March agers. Int J Environ Res Public Health 2013;10:5062–5082. 2016, date last accessed). 17. Harrison J, Woods A, Dickson K. Occupational health 21. Steadman K, Taskila T. Symptoms of Depression and purchasing behaviour by SMEs—a new theoretical model. Their Effects on Employment. Summary Report. The Work Occup Med (Lond) 2013;63:510–512. Foundation, 2015. http://www.theworkfoundation. 18. Hanson M, Demou E, Bakhshi A et al. Evaluation of W or king com/wp-content/uploads/2016/11/382_Symptoms- Health Services Scotland, 2010–2014. 2016. http://www.gov. of-Depression_FINAL.pdf (March 2016, date last scot/Resource/0050/00502387.pdf (July 2016, date last accessed). accessed). 22. Scottish Government. Regional Employment Patterns 19. WHSS. Working Health Services Scotland (WHSS). 2016. in Scotland: Statistics from the Annual Population http://www.gov.scot/Topics/Health/Healthy-Living/Health- Sur vey, 2015. 2015. http://www.gov.scot/Publications/ Work/Projects. (July 2016, date last accessed). 2016/05/8208. (March 2016, date last accessed). doi:10.1093/occmed/kqx137 Corbett McDonald Corbett McDonald, one of the truly colossal figures in (SWORD) and skin diseases amongst others. He worked occupational health, died in 2016. In ‘Farewell to Corbett, on sick building syndrome, solvent exposure and psy- but Not to His Contributions’ Trevor Ogden and Graham chiatric disorders, chemical exposure and congenital Gibbs commemorate the first anniversary of his death in defects and spontaneous abortion. He studied flour and the Annals of Workplace Exposures and Health [1]. other aeroallergens, silica in potteries and cryptogenic John Corbett McDonald was born in Belfast fibrosing alveolitis. During his career he was head of the in April 1918. He qualified at St Mary’s Hospital TUC Centenary Institute of Occupational Health at Medical School, was an army medical officer during the London School of Hygiene and Tropical Medicine World War II and then trained in public health at the and Professor Emeritus of Clinical Epidemiology at the London School of Hygiene and Tropical Medicine National Heart and Lung Institute. and at Harvard University. He became director of the Corbett remained active well into old age despite los- Epidemiological Research Laboratory at the Public ing a leg after being hit by a motorcycle. He authored over Health Laboratory at Colindale in 1960 before mov- 70 of his 319 papers after his 70th birthday, the last one ing to chair the new Department of Epidemiology appearing in the Annals in 2010 when he was 92. At the and Health at McGill University in Montreal in 1964. age of 93 he made several visits to Bangladesh where he Together with Dr Christopher Wagner, newly arrived helped set up a postgraduate training scheme and worked from the Pneumoconiosis Research Unit near Cardiff, on the effects of arsenic contamination of drinking water. he began his research interest in asbestos. Funding was However, even in his eighties, Corbett’s personal integrity obtained from the asbestos industry at a time when such was attacked and demands made for McGill University funding for research was not unusual. In a retrospective to investigate his research. Finally and eventually the cohort study of 11000 Quebec chrysotile miners and Research Integrity Officer of McGill concluded that ‘there millers born between 1891 and 1920, they found excess is no evidence that the design of the research, its conduct, lung cancer deaths at ‘extremely high dust exposure’, and its reporting was influenced by the industry’. but little or no excess below levels ‘orders of magnitude You can read the full article from which this higher than permitted today’. In 1972, Corbett advised abridged version is adapted at https://doi.org/10.1093/ the International Agency for Research on Cancer which annweh/wxx013. concluded that all commercial types of asbestos could cause lung cancer. Whilst his work was one of the major John  Hobson studies that contributed to understanding the risk of e-mail: hon.editor@som.org.uk asbestos disease, Corbett was publicly attacked by those who disagreed with his findings and the use made of them by the asbestos industry. This assault lasted for Reference most of Corbett’s lifetime and threatened to overshadow his other considerable contributions to occupational 1. Ogden T, Gibbs G. Farewell to Corbett, but not to his health. He initiated a series of occupational disease contributions. Ann Work Expo Health 2017;61:499–503. doi:10.1093/annweh/wxx013. surveillance schemes including respiratory diseases http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

Working Health Services Scotland: a 4-year evaluation

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Oxford University Press
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Copyright © 2022 Society of Occupational Medicine
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0962-7480
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1471-8405
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10.1093/occmed/kqx186
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Abstract

Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 Occupational Medicine 2018;68:38–45 Advance Access publication 30 January 2018 doi:10.1093/occmed/kqx186 Working Health Services Scotland: a 4-year evaluation 1,2 3 2 4 2 E. Demou , M. Hanson , A. Bakhshi , M. Kennedy and E. B. Macdonald MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow G2 3QB, UK, Healthy Working Lives Group, Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, 3 4 UK, WorksOut, The Green House, Edinburgh EH4 1NR, UK, Salus Occupational Health, Safety & Return to Work Services, Hamilton ML3 0TA, UK. Correspondence to: E. Demou, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top Floor, 200 Renfield Street, Glasgow G2 3QB, UK. Tel: +44 (0)141 353 7580; fax: +44 (0)141 332 0725; e-mail: evangelia.demou@ glasgow.ac.uk Background Working Health Service Scotland (WHSS) supports the self-employed and employees of small and medium-sized enterprises (SMEs) in Scotland with a health condition affecting their ability to work, who are either absent or at risk of becoming absent due to it. Aims To evaluate the impact on health and work outcomes of WHSS clients over a 4-year period. Methods Data were collected at enrolment, entry, discharge and follow-up at 3 and 6 months after discharge. Clients completed up to three validated health questionnaires at entry and discharge—EuroQol five dimensions (EQ-5D) and visual analogue scale (VAS); Hospital Anxiety and Depression Scale (HADS); and Canadian Occupational Performance Measure (COPM). Results A total of 13 463 referrals occurred in the 4-year period; 11 748 (87%) were eligible and completed entry assessment and 60% of the latter completed discharge paperwork. The majority of referrals were due to musculoskeletal conditions (84%) while 12% were referred with mental health condi- tions. Almost a fifth (18%) of cases were absent at entry and back at work at discharge. Work days lost while in WHSS was associated with age, length of absence prior to entering WHSS, primary health condition and time in programme. All health measures showed significant improvements from entry to discharge. Improvement in general health was sustained at 3- and 6-month follow-up. Conclusions The WHSS evaluation findings indicate that participation was associated with positive changes to health and return-to-work. The extent of the positive change in health measures and work ability can be highly important economically for employees and employers. Key words Case management; intervention; mental health; musculoskeletal disorders; return-to-work; sickness absence; SME. SA interventions. Although only responsible for a small Introduction percentage of SA events, long-term SA events account Sickness absence (SA) is a public health issue with sub- for ~75% of absence costs [2,6]. Workplace interven- stantial impacts on employers, employees, health care tions targeted at improving physical and psychosocial systems and society [1–3]. The longer someone is ab- health [7–9], quality of life [10], emotional well-being sent, the higher the risk of not returning to work [3]. As [11], presenteeism [11], absenteeism [12] and SA [13] SA is multicausal, the biopsychosocial (BPS) model has are effective. The workplace is often a conducive environ- been used in the management of SA [4] and is recog- ment to implement programmes and practices to pro- nized by the World Health Organization (WHO) [5] as mote employee health and well-being [14]. an appropriate model. Employees of small and medium-sized enterprises Mental health (MH) and musculoskeletal disorders (SMEs) and the self-employed are most likely to have (MSD) are the leading cause of long-term SA [1,2]. little or no formal occupational health (OH) support These are of particular interest because improving [15]. A  study on the health and well-being needs of return-to-work (RTW) times is one of the main goals of SME employees found SA and presenteeism to be two © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 39 emerging themes [14]. The characteristics, working pat- questionnaire (EQ-5D) and visual analogue scale (EQ- terns and culture in SMEs further impact on absentee- 5D VAS), the Hospital Anxiety and Depression Scale ism and presenteeism rates [16]. The size of the SME, (HADS) and the Canadian Occupational Performance and their knowledge of OH and its importance, influence Measure (COPM). EQ-5D was included in the 3- and provision of OH services in SMEs [17]. A  large num- 6-month follow-up [8]. ber of SMEs understand and monitor SA and its impact Clients completed telephone assessments to establish on their organization [17], whereas only a small frac- eligibility and provide consent, followed by a telephone tion undertake health promotion activities [15]. SME- assessment by the case manager [18]. Where required, specific information about the occurrence of SA and clients were referred to services either within or external work attendance behaviour when dealing with a health to WHSS (appointments within 5–10 working days from issue and the variables that influence these decisions is referral). Case managers monitored progress and clients needed for the development of tailored interventions for were discharged when suitable improvements in health/ this sector [16]. work ability were achieved or if WHSS was no longer The Working Health Service Scotland (WHSS) pro- supporting them adequately. Discharged clients were fol- gramme, funded by the Scottish Government and UK lowed up 3 and 6 months post-discharge. Department for Work and Pensions (DWP), was devel- Descriptive statistics analysed demographics, health oped to help meet this need within SMEs [18]. It pro- condition, and health assessment scores pre-/post-inter- vides telephone-based case management and some vention and at follow-up. Univariate analysis was used face-to-face therapeutic support to SME employees to investigate differences pre-/post-intervention. A  gen- whose health condition affects their ability to work [19]. eral linear model was used to examine significant pre- WHSS aims to provide support for health conditions dictors of the degree of change in the health assessment which may impact on the clients’ work and/or other areas scores. Multivariate statistical analysis was used to inves- of their lives, to allow them to RTW (if absent) or remain tigate the relationships between the routinely collected in work (if not absent). variables and explore which predictor variables were The service is provided in 11 health board areas in associated with the outcome variable(s). Predictor vari- Scotland (out of 14), with clients from outside these areas ables included age, gender, deprivation (Scottish Index being managed by other boards [18]. The self-employed of Multiple Deprivation, SIMD), health condition and and SME (<250 employees) employees in Scotland can work status. For clients who completed WHSS, number self-refer, or be referred by a general practitioner (GP) or of therapeutic sessions attended, programme duration allied health professional (AHP); employers cannot make and therapies received were also predictor variables. The referrals. WHSS uses a BPS approach with an occupa- outcome variable was programme completion (dichot- tional focus and provides physiotherapy, occupational omous: completed/discharged); and for those who com- therapy and psychological therapy/counselling where pleted the difference in pre- and post-intervention health appropriate. Care is coordinated by a case manager. assessment scores was investigated. In a second analysis, This study aimed to investigate the health and work/ the outcome was work status (dichotomous: in work/ab- functional outcomes of WHSS clients referred between sent) at time of exit from WHSS. 2010 and 2014 and understand the factors associated This is a retrospective study using secondar y anonymized with programme completion and RTW. data. Ethical approval was not required as confirmed by the NHS Lanarkshire Research & Development Manager. Methods Results Client data enrolled between 26 March 2010 and 31 March 2014 (including discharge data to 28 July A total of 13 463 referrals were made over the study period, 2014)  were analysed [18]. Data collection points included: with 11 748 cases (87%) eligible with completed entry enrolment (WHSS eligibility assessment, i.e. working for assessments. Some individuals entered the programme a Scottish SME); entry (first telephone assessment by more than once, so the number of unique individuals (i.e. case manager—‘pre-intervention’); therapy provision (ser- ‘clients’) is less than the number of referrals (i.e. ‘cases’). vices received); discharge (discharge from WHSS—‘post- The majority (92%) of referrals were new referrals; 5% intervention’); 3-month post-discharge follow-up (recording were re-referring with a new health condition; and 3% health measures, work ability and absence status); and were re-referring with the initial health condition. The 6-month post-discharge follow-up (repeat of data gathered analysis hereafter is based on the number of ‘cases’ and not at 3-month follow-up). Demographic, health (present- ‘clients’, so each individual referral is considered unique. ing conditions) and employment status (at work/absent) Overall 7% of females and 6% of males re-entered WHSS, data were collected at entry. Clients also completed with older clients more likely to re-enter [18]. up to three standard, validated health questionnaires The number of cases significantly increased with at entry and discharge—the EuroQol five dimensions increasing SIMD category (P  <  0.01) (Table  1). Most Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 40 OCCUPATIONAL MEDICINE Table 1. Demographic details at entry by SIMD quintiles Cases pre-intervention SIMD quintiles Whole sample 1 (most deprived) 2 3 4 5 (least deprived) Number 1718 2228 2467 2626 2709 11 748 Average age (SD) (years) 43.3 (12) 43.5 (12) 44.6 (12) 45.7 (12) 45.4 (12) 44.6 (12) Gender Female (%) 49 47 49 48 48 48 Male (%) 50 52 50 51 51 51 Missing/not specified (%) 0.4 0.8 0.5 0.7 0.8 0.6 Primary health condition MSD (%) 85 83 83 85 85 84 MH (%) 12 14 13 11 11 12 Other (%) 3 3 4 4 4 4 Employment status Full-time (%) 74 77 75 78 75 76 Part-time (%) 26 23 25 22 25 24 Absent at entry (%) 24 22 22 21 19 21 demographic data were relatively similar across SIMD information on absence duration prior to entry to WHSS, quintiles, with the exception of age and absence status at with 36% absent for <2 weeks and 20% absent for >12 entry (Table 1). The greatest proportion of cases (21%) weeks (Figure S1, available as Supplementary data at came from the standard occupational classification Occupational Medicine Online). (SOC) group SOC-5: skilled trades occupations, while Forty-one per cent of cases who entered the pro- the smallest (7%) came from SOC-8: process, plant gramme did not complete the discharge paperwork. This and machine, and SOC-9: elemental occupations. The analysis is based on the data received from those who majority of cases were referred with a MSD (84%); while completed at least some of the discharge paperwork. 12% were referred with a MH condition. All other health The average time in WHSS was 121  ±  81  days (Table conditions were categorized as ‘Other’ (4%). This paper S2, available as Supplementary data at Occupational focuses on MSD and MH cases. Medicine Online). Overall, half (50%) of the 11 103 There was a significant association between depriv- cases, for whom there were entry EQ-5D scores, com- ation (SIMD) and primary condition (P  < 0.05); cases pleted the discharge EQ-5D. Socio-demographic char- in SIMD 2 and 3 were 1.2 and 1.1 times more likely, re- acteristics between those that completed the programme spectively, to have MH as their primary condition com- were similar to the entire WHSS population for gender, pared to the least deprived (SIMD 5). There was also a primary health condition, SIMD and absence status at strong association between gender and primary condi- entry. Multivariate analysis showed that age was a signifi- tion (P  <  0.01), with women twice as likely as men to cant predictor of completion (P  <  0.001) and number present with a MH condition (relative risk [RR] = 2.00; of services and longer duration in WHSS were inversely 95% CI: 1.81 to 2.22). Type of occupation was also associated with the odds of completing discharge paper- associated with primary condition (P  <  0.01); all oc- work (P < 0.001) [18]. cupational groups had a higher risk of MH conditions The majority of cases (75%) were at work at entry and compared to SOC-5, with the associate professional and discharge, while 4% were absent at entry and discharge. technical occupations group (SOC-3) having the highest However, 18% (n = 1188) who were absent at entry were risk overall (three times higher risk of MH conditions at work at discharge. Two per cent were at work at entry compared to SOC-5). and absent at discharge. Cases more likely to be absent at A secondary health condition was reported by 2154 discharge included cases: in the most deprived compared cases (16%); 24% of MH cases had a secondary health to least deprived group (RR  =  1.89; 95% CI: 1.42 to condition (most commonly another MH condition), 2.53); aged over 50 compared to 30–39 years old group while 15% of MSD cases had a secondary condition (RR = 1.44; 95% CI: 1.09 to 1.92); with MH rather than (most commonly another MSD) (Table S1, available as MSD conditions (RR  =  1.89; 95% CI: 1.50 to 2.39); Supplementary data at Occupational Medicine Online). and cases absent at entry were six times more likely to be A quarter of cases (n  =  2902) were absent at entry. absent at discharge compared to those at work at entry By primary health condition, 21% (n = 2121) of MSD (RR = 6.04; 95% CI: 5.00 to 7.30). cases and almost double (41%; n  =  589) of MH cases Number of working days lost since entering WHSS were absent at entry. A  total of 2145 cases provided was available for 649 cases. Overall, 50% were back to Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 41 work in 27 days (95% CI: 25 to 29) (Figure 1a). Number durations; for every 10 additional days in the programme, of days lost was significantly higher in MH than MSD 2 days of SA were added. cases (P < 0.001); 50% of MH and MSD cases returned All health measures recorded a statistically signifi- to work in 46 and 21 days, respectively. Number of days cant beneficial change between entry and discharge lost was also significantly higher for cases absent longer (P  <  0.001) (Table  3); the change in HADS scores for prior to entering WHSS (P < 0.001). MH cases was greater than for MSD cases, while the The best-fit model for SA duration (Table 2) included changes in the other measures were more similar when age, length of absence before entering WHSS, primary comparing by health condition. condition and discharge time. Gender, SIMD, occupa- In total, 88% (n  =  4920) of cases improved their tion and general health status at entry were not signifi- EQ-5D index score by an average of 0.35 (P  <  0.001). cant. Age added almost 5 days to SA duration while in By primary health condition, 89% of MSD and 84% of the programme for every 10-year age category. Moving MH cases improved their EQ-5D score, with a slightly up in SA duration prior to entry categories, 10 days were greater increase for MSD cases (Figure S2a, available as added to SA duration while in the programme. Duration Supplementary data at Occupational Medicine Online). of SA reduced by 10  days for cases presenting with By absence status at entry (Figure S2b, available as MSD compared to MH conditions. Longer SA periods Supplementary data at Occupational Medicine Online), while in WHSS were associated with longer programme 88% of those at work (n = 4267) and 88% of those absent Figure 1. Survival analysis; (a) Kaplan–Meier RTW curve for all: number of days lost due to SA (solid line) with 95% CI (dotted line; N = 649); (b) Kaplan–Meier RTW curve by primary condition (MH = mental health cases; MSD = musculoskeletal cases); and (c) median length of time (days) being absent since entry assessment by the number of weeks absent before entry assessment. Table 2. Model result of ARIMA model for duration of SA of referrals Model parameters Estimate (days) Standard error of estimates Z-statistic P-value Age (years) 0.49 0.16 3.04 <0.01 Duration of SA prior to entering the programme (ref = 0–2 9.91 1.81 5.47 <0.001 weeks) Primary condition (ref = MH) −10.60 3.65 2.90 <0.01 Discharge time (days) 0.22 0.03 8.23 <0.001 SA duration prior to entry assessment was re-coded for the analysis (1 = 0 to 2 weeks; 2 = 3 to 5 weeks; 3 = 6 to 8 weeks; 4 = 9 to 11 weeks; 5 = over 12 weeks). Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 42 OCCUPATIONAL MEDICINE Table 3. Average changes in health measure scores Measure Pre-intervention Post-intervention Average change in Number 95% CI mean score mean score score EQ-5D index All completers 0.51 0.81 0.30 5590 [0.29 to 0.31] MSD cases 0.50 0.81 0.31 4749 [0.29 to 0.31] MH cases 0.58 0.84 0.26 646 [0.26 to 0.29] EQ-5D VAS score All completers 59.1 80.0 22.5 5472 [22.49 to 22.50] MSD cases 60.6 80.8 22.5 4653 [22.49 to 22.50] MH cases 48.8 76.2 30.0 631 [27.50 to 30.00] COPM Performance score All completers 3.84 7.54 3.70 3771 [3.99 to 4.00] MSD cases 3.91 7.62 3.71 3182 [4.00 to 4.04] MH cases 3.27 7.26 3.99 457 [4.00 to 4.50] COPM Satisfaction score All completers 2.87 7.44 5.00 3754 [4.99 to 5.00] MSD cases 2.91 7.53 5.00 3166 [5.00 to 5.17] MH cases 2.46 7.18 5.00 457 [4.75 to 5.25] HADS anxiety score All completers 7.36 4.04 −3.32 1696 [−4.00 to −3.50] MSD cases 5.57 3.26 −2.31 1203 [−3.00 to −2.50] MH cases 12.67 6.18 −6.50 400 [−7.50 to −6.50] HADS depression score All completers 5.94 2.80 −3.14 1696 [−3.50 to −3.00] MSD cases 4.68 2.33 −2.35 1203 [−3.00 to −2.50] MH cases 9.65 3.98 −5.67 400 [−6.50 to −5.50] COPM Performance and Satisfaction scores range from 0 to 10; a higher score represents better performance, and better satisfaction. HADS scores range from 0 to 21, while 0–7 is considered ‘normal’, 8–10 ‘borderline’ and 11–21 is ‘caseness’. Note also that a negative change in score for the HADS anxiety and depression scores indicates an improvement. (n = 1323) improved their EQ-5D score, by 0.28 and 0.35, improved by an average of 4.1, n  =  1203). The change respectively. Similarly, 81% improved their EQ-5D VAS in scores was also greater for those absent at entry scores by an average score of 27.8 points (P < 0.001). Of (80% improved by an average of 5.9, n  =  490) com- those who improved their score MH cases demonstrated a pared with those at work (70% improved by an aver- 6-point greater change compared with MSD cases (Figure age of 4.7, n = 1206) (Table S3d and S3e, available as S2c, available as Supplementary data at Occupational Supplementary data at Occupational Medicine Online). Medicine Online). Mean VAS score was higher both at A ‘caseness’ status for depression was reported by entry and discharge for MSD compared with MH cases 18% at entry and dropped to 5% at discharge (Table (Table 3). By absence status at entry (Figure S2d, available S4a, available as Supplementary data at Occupational as Supplementary data at Occupational Medicine Online), Medicine Online). A total of 455 (27%) cases transitioned a greater proportion of those who were absent at entry to a healthier category, with 12% transitioning from the improved their VAS score, than those who were at work. worst category ‘caseness’ to ‘normal’. Improvement in HADS scores show nearly one-third of cases (29%) scores was greater for MH (85% improved by an aver- had ‘caseness’ anxiety status at entry, changing to just age of 7%, n = 400) compared with MSD cases (66% 8% at discharge (Table S3a, available as Supplementary improved by an average of 4.0, n = 1203) (Table S4b and data at Occupational Medicine Online). In total, 574 S4c, available as Supplementary data at Occupational cases (34%) transitioned to healthier anxiety catego- Medicine Online). The change in scores was also greater ries, with 17% transitioning from the worst state ‘case- for those absent at entry (79% improved by an aver- ness’ to normal (Table S3a, available as Supplementary age of 6.1, n = 490) compared with those at work (69% data at Occupational Medicine Online). By primary improved by an average of 4.3, n = 1206) (Table S4d and health condition, 23% of MSD (Table S3b, avail- S4e, available as Supplementary data at Occupational able as Supplementary data at Occupational Medicine Medicine Online). Online) and 69% of MH cases (Table S3c, available as COPM Performance scores increased for 89% of Supplementary data at Occupational Medicine Online) cases (n = 3771) by 4.2 points on average. Improvements moved to a healthier anxiety state. Improvement in were similar for both MSD and MH cases (Figure S3a, scores was greater for MH (89% improved by an aver- available as Supplementary data at Occupational Medicine age of 8%, n = 400) compared with MSD cases (67% Online); and greater for those absent at entry than those Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 E. DEMOU ET AL.: WORKING HEALTH SERVICES SCOTLAND 43 at work at entry (Figure S3b, available as Supplementary An important finding was the relationship between data at Occupational Medicine Online). age and SA duration, with there being on average Similarly, 90% of cases improved their COPM five more days of absence for every 10  years of age. Satisfaction score (n  =  3754) by 5.1 on average. Older workers may have longer SA, although gener- Improvements were similar for both MSD and MH ally have fewer SA episodes [20]. This finding indi- cases (Figure S3c, available as Supplementary data at cates the need for improved OH and routine care for Occupational Medicine Online); and greater for those older workers. absent at entry than those at work at entry (Figure S3d, The majority of cases in WHSS had an MSD (84%), available as Supplementary data at Occupational Medicine which does not appear to reflect the fact that common MH Online). disorders are a leading cause of SA [21]. This may suggest Altogether 2033 cases provided EQ-5D follow-up that a significant proportion of the workforce experienc- data at ~3  months, 6  months, or both 3 and 6  months ing a MH condition may not be accessing this service. after discharge and these figures demonstrate a sus- Ways of addressing this should be considered in any future tained improvement in EQ-5D scores at 3 and 6 months programmes. Health improvements and RTW outcomes (Figure 2). were generally better for MH than MSD cases, although they generally entered the programme with worse health scores and longer absence durations prior to entry. Discussion The uniqueness and richness of this data set, covering All health measures showed significant improvements an often hard-to-reach population—i.e. SME employees from entry to discharge in health and functional ability; with health issues—are significant study strengths. Using the majority of WHSS cases experienced health benefits. secondary routine data, we analysed changes in health, COPM scores significantly improved in 90% of cases, well-being and work ability pre-/post-intervention. The evidencing positive impacts on functional capacity and study included a large sample, a large number of socio- coping. The 3- and 6-month follow-ups provide evidence demographic variables and the use of up to three stand- of the sustainability of the health improvements seen at ardized health/function assessment tools. Cases broadly discharge, and of cases remaining in work and working represented the demographics of Scottish workers in normal working hours after leaving WHSS. terms of gender [22], while the service supported more An integral part of the case management process older workers (>50 years) than the proportion reflected was to identify co-morbidities, which were present in in Scottish employment statistics [22]. This is important 24% and 15% of cases with MH and MSD conditions, given that older workers may have greater needs for such respectively. Identifying these co-morbidities will have services in light of policies to extend working lives. The helped case managers to provide more holistic care. study covered the two leading causes of SA and work This is evident in the HADS scores of individuals with incapacity [6]. This highlights the need for services sup- MSD primary conditions where there was a 23% and porting those with MSD and MH conditions affecting 17% reduction of anxiety and depression symptoms, work ability. respectively. Co-morbidities are not always recognized in As is the case in many service evaluations, the lack routine care but are likely to influence clinical and func- of a control population is the main study limitation. tional outcomes. Discharge data were only available for 60% of eligible Figure 2. EQ-5D index score for entry, discharge, 3 and 6 months post-discharge. Downloaded from https://academic.oup.com/occmed/article/68/1/38/4830142 by DeepDyve user on 14 July 2022 44 OCCUPATIONAL MEDICINE cases, primarily due to not being able to contact the non- Gibson, Patsy Cavanagh and Cathy Evans for their helpful dis- cussions regarding WHSS and the evaluation. completers (60% of non-completers), or their voluntary withdrawal (15%). While the results demonstrate an improvement in health status that was sustained at 3 and Conflicts of interest 6 months post-discharge and an overall improvement in None declared. work status, the lack of a control means the effectiveness of WHSS cannot be assessed, as it is not possible to meas- References ure the health and employment outcomes for individuals who did not receive this service, and those who did not 1. Ritchie KA, Macdonald EB, Gilmour WH, Murray KJ. complete it. 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Working Health Services Scotland (WHSS). 2016. in Scotland: Statistics from the Annual Population http://www.gov.scot/Topics/Health/Healthy-Living/Health- Sur vey, 2015. 2015. http://www.gov.scot/Publications/ Work/Projects. (July 2016, date last accessed). 2016/05/8208. (March 2016, date last accessed). doi:10.1093/occmed/kqx137 Corbett McDonald Corbett McDonald, one of the truly colossal figures in (SWORD) and skin diseases amongst others. He worked occupational health, died in 2016. In ‘Farewell to Corbett, on sick building syndrome, solvent exposure and psy- but Not to His Contributions’ Trevor Ogden and Graham chiatric disorders, chemical exposure and congenital Gibbs commemorate the first anniversary of his death in defects and spontaneous abortion. He studied flour and the Annals of Workplace Exposures and Health [1]. other aeroallergens, silica in potteries and cryptogenic John Corbett McDonald was born in Belfast fibrosing alveolitis. During his career he was head of the in April 1918. He qualified at St Mary’s Hospital TUC Centenary Institute of Occupational Health at Medical School, was an army medical officer during the London School of Hygiene and Tropical Medicine World War II and then trained in public health at the and Professor Emeritus of Clinical Epidemiology at the London School of Hygiene and Tropical Medicine National Heart and Lung Institute. and at Harvard University. He became director of the Corbett remained active well into old age despite los- Epidemiological Research Laboratory at the Public ing a leg after being hit by a motorcycle. He authored over Health Laboratory at Colindale in 1960 before mov- 70 of his 319 papers after his 70th birthday, the last one ing to chair the new Department of Epidemiology appearing in the Annals in 2010 when he was 92. At the and Health at McGill University in Montreal in 1964. age of 93 he made several visits to Bangladesh where he Together with Dr Christopher Wagner, newly arrived helped set up a postgraduate training scheme and worked from the Pneumoconiosis Research Unit near Cardiff, on the effects of arsenic contamination of drinking water. he began his research interest in asbestos. Funding was However, even in his eighties, Corbett’s personal integrity obtained from the asbestos industry at a time when such was attacked and demands made for McGill University funding for research was not unusual. In a retrospective to investigate his research. Finally and eventually the cohort study of 11000 Quebec chrysotile miners and Research Integrity Officer of McGill concluded that ‘there millers born between 1891 and 1920, they found excess is no evidence that the design of the research, its conduct, lung cancer deaths at ‘extremely high dust exposure’, and its reporting was influenced by the industry’. but little or no excess below levels ‘orders of magnitude You can read the full article from which this higher than permitted today’. In 1972, Corbett advised abridged version is adapted at https://doi.org/10.1093/ the International Agency for Research on Cancer which annweh/wxx013. concluded that all commercial types of asbestos could cause lung cancer. Whilst his work was one of the major John  Hobson studies that contributed to understanding the risk of e-mail: hon.editor@som.org.uk asbestos disease, Corbett was publicly attacked by those who disagreed with his findings and the use made of them by the asbestos industry. This assault lasted for Reference most of Corbett’s lifetime and threatened to overshadow his other considerable contributions to occupational 1. Ogden T, Gibbs G. Farewell to Corbett, but not to his health. He initiated a series of occupational disease contributions. Ann Work Expo Health 2017;61:499–503. doi:10.1093/annweh/wxx013. surveillance schemes including respiratory diseases

Journal

Occupational MedicineOxford University Press

Published: Feb 16, 2018

Keywords: follow-up; health services; mental health; musculoskeletal diseases; job reentry; clients; hospital anxiety and depression scale; employer; self-employed; case management; illness; performance measures; economics

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