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1.
Rev Epidemiol Sante Publique ; 67(4): 247-252, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31235191

RESUMO

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.


Assuntos
Disparidades em Assistência à Saúde , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Idoso , Ética Médica , Feminino , França/epidemiologia , Geografia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/economia , Doenças Profissionais/terapia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/ética , Serviços de Saúde do Trabalhador/organização & administração , Serviços de Saúde do Trabalhador/normas , Fatores Socioeconômicos , Indenização aos Trabalhadores
2.
JAMA ; 321(15): 1491-1501, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990549

RESUMO

Importance: Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. Objective: To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. Design, Setting, and Participants: This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. Interventions: There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Main Outcomes and Measures: Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Results: Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Conclusions and Relevance: Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. Trial Registration: ClinicalTrials.gov Identifier: NCT03167658.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde , Nível de Saúde , Saúde do Trabalhador , Adulto , Comércio , Feminino , Gastos em Saúde , Promoção da Saúde/economia , Humanos , Masculino , Serviços de Saúde do Trabalhador/economia , Aceitação pelo Paciente de Cuidados de Saúde , Autorrelato , Inquéritos e Questionários , Estados Unidos , Local de Trabalho
4.
Int J Occup Med Environ Health ; 32(3): 353-361, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-30356227

RESUMO

OBJECTIVES: In the contemporary Western culture, working population health issues, stressed in various publications, have been perceived as a crucial part of public health. To deal with occupational health issues properly, occupational health services (OHS), aiming at the protection of the workers' health, are organized in many countries. The survey was to find the differences in occupational health systems that the European Economic Area countries use in order to execute prophylactic activities focused on diseases of affluence and how the OHS are used for health promotion actions. MATERIAL AND METHODS: The survey was conducted with the use of an on-line expert questionnaire. No deep statistical analysis was performed as for the designed aims of the study simple statistics were sufficient. RESULTS: All the reviewed countries have organized OHS. The funding mechanisms are based mainly on the financial involvement of employers. In the majority of countries, the main goal of the OHS is certification of the ability to work. Workplace surveillance aiming at the occupational risk assessment and health promotion activities that focus on work-related and/or occupational diseases are the most popular services provided within national systems. CONCLUSIONS: Occupational health professionals are well placed to perform actions directed at health promotion and prophylactics of a wide range of diseases - not only occupational/work-related, but also non-communicable, particularly life-style-related diseases of affluence. The engagement of the occupational medical services (OMS) in prevention of the non-work-related health issues would be valuable. However, it would be inevitable for employers to finance a wider range of services to a greater extent. Int J Occup Med Environ Health. 2019;32(3):353-61.


Assuntos
Promoção da Saúde/organização & administração , Doenças Profissionais/prevenção & controle , Serviços de Saúde do Trabalhador/estatística & dados numéricos , União Europeia , Política de Saúde , Humanos , Estilo de Vida , Saúde do Trabalhador/estatística & dados numéricos , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/organização & administração , Inquéritos e Questionários , Local de Trabalho
5.
Am J Health Promot ; 33(2): 285-288, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29969913

RESUMO

PURPOSE: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. DESIGN: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. SETTING: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. PARTICIPANTS: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. MEASURES: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. ANALYSIS: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. RESULTS: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. CONCLUSIONS: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.


Assuntos
Linhas Diretas/estatística & dados numéricos , Serviços de Saúde do Trabalhador/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/métodos , Análise Custo-Benefício , Linhas Diretas/economia , Humanos , Kentucky , Serviços de Saúde do Trabalhador/economia , Estudos Retrospectivos , Abandono do Hábito de Fumar/economia , Abandono do Uso de Tabaco/economia
6.
Med Pr ; 69(6): 673-684, 2018 12 18.
Artigo em Polonês | MEDLINE | ID: mdl-30468207

RESUMO

This paper constitutes a continuation of the critical analysis of legal aspects of psychological examinations in some group of workers. In this part the appeal procedure, documentation, costs of examinations and supervision are discussed. The analysis has shown many deficiencies in regulations related to all aspects of psychological examinations. They arise from incoherence of legal regulations and the lack of regulations of some questions. This legal standing is restricted to occupational work and adversely affects the quality of supplied services. Therefore acts of law and regulations relevant to psychological examinations for the purpose of fitness-to-work certification need necessary adjustments. According to authors it is desirable to end the legal procedure amending the act of law on a profession of psychology and the self-government of psychologists, as well as to develop and implement executive regulations. Med Pr 2018;69(6):673-684.


Assuntos
Serviços de Saúde do Trabalhador/legislação & jurisprudência , Testes Psicológicos , Custos e Análise de Custo , Humanos , Serviços de Saúde do Trabalhador/economia
7.
Artigo em Inglês | MEDLINE | ID: mdl-30469425

RESUMO

An emerging issue in occupational health and safety (OHS) is that interventions increasingly have to demonstrate that they offer sufficient value for money. To this end, the last decennia have seen more and more economic evaluation methods being employed in this field. However, several recent publications have indicated that many of the published studies suffer from important shortcomings. This paper aims to highlight difficulties in assessing the value of OHS by use of current economic evaluation methods. First, a summary framework presents an overview of the costs and benefits relevant for OHS interventions. Next, three elements from this framework are selected that are at the same time crucial to OHS value, but also challenging to measure and monetise: Effects on worker productivity, 'intangible' benefits, such as reputation effects, and the influence of the broader legal⁻fiscal context in which an intervention takes place. The following sections then discuss the following research questions for each of these elements: Why is it difficult to exclude these factors from OHS economic evaluations? Why do they pose a challenge to the quality of economic evaluations in OHS? How can they be included, and what are the known advantages and disadvantages of the methods to measure these factors? Future work should investigate (and standardise) better methods to include these elements.


Assuntos
Análise Custo-Benefício/métodos , Serviços de Saúde do Trabalhador/economia , Humanos , Local de Trabalho
8.
Nihon Eiseigaku Zasshi ; 73(3): 413-420, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-30270309

RESUMO

INTRODUCTION: From 2007, competitive bidding for procurement became widely employed by the Japanese Government, and health check providers for government workers are selected every year by this method. Deterioration of health check quality due to excessive price competition is a serious concern. The National Federation of Industrial Health Organization (Zeneiren) conducted an investigative research on the contracting of health check providers and occupational physicians in workplaces in 2015-2016 in an effort to prevent low-cost but low-quality health checks. The report of the research is available on the homepage of Zeneiren. In this paper, we provide a brief overview of the report, and deterioration of health check quality due to dumping by and switching of health check providers is discussed from economic and legal viewpoints. METHOD: Information was obtained from articles in print and on the Internet. RESULTS: A questionnaire survey of health check providers revealed that excessive discounts due to both competitive bidding and demand from companies commissioning health checks occurred on a routine basis, and some providers were concerned about worsening business conditions in the future. In a separate questionnaire survey of occupational physicians, it was discovered that they were able to evaluate the quality of health checks, whereas administrative officials responsible for selecting the providers were seldom able to adequately evaluate the health check quality, resulting in contracting providers of questionable quality, which in turn caused considerable dissatisfaction on the part of occupational physicians. Moreover, when health check providers were switched, the reporting format of health check results changed. The physicians did not favor such a change because of the considerably increased workload involved in coordinating past and current data and the risk of decreased occupational health service quality. DISCUSSION: Dumping makes the management of health check providers very difficult and is a cause of loss of social capital. If health check providers of good quality withdraw from the market, the supply of high-quality health checks decreases. This corresponds to external diseconomy caused by dumping on the part of the health check providers and loss of social surplus (economic surplus). CONCLUSIONS: To avoid deterioration of occupational health service due to low-quality health checks and changes in the reporting format, occupational physicians must actively engage in the selection of health check providers of good quality.


Assuntos
Serviços de Saúde do Trabalhador/economia , Medicina do Trabalho/economia , Exame Físico/economia , Médicos/economia , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à Saúde/economia , Humanos , Japão , Inquéritos e Questionários , Local de Trabalho
9.
Artigo em Inglês | MEDLINE | ID: mdl-30082646

RESUMO

BACKGROUND: Occupational safety and health issues are closely associated with the wellbeing and survival of every worker and family, as well as of society as a whole. It is a type of typical public issue and requires cooperative governance among different governing subjects. METHODS: According to the questionnaire investigation on 2179 subjects with different identities, the research explored the willingness to pay (WTP) for occupational safety and health and the degree of attention, with different identities, through the difference analysis and descriptive statistical analysis. The research studied the relationship between public attention and WTP through the methods of cross-analysis, correlation analysis, and regression analysis. RESULTS: (1) The public show a disregard attitude to occupational safety and health. (2) The public expect the government to fund and solve occupational safety and health problems rather than for themselves to pay directly. (3) Over 50% of questionnaire respondents defined occupational safety and health problems as being classified into two categories, namely, "no attention-government payment" or "no attention-refusal of individual payment", according to the analysis. (4) The level of attention paid to occupational safety and health can significantly predict the individual income WTP, item WTP, subject WTP, and event WTP. CONCLUSIONS: This research aimed to outline the implications for the governance of occupational safety and health.


Assuntos
Política de Saúde , Serviços de Saúde do Trabalhador/economia , Saúde do Trabalhador/economia , Opinião Pública , Atenção , China , Humanos , Análise de Regressão , Inquéritos e Questionários
10.
Br Med Bull ; 126(1): 113-121, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29684103

RESUMO

Background: Governments and employers' organizations have sustained focus on common mental disorders (CMD), how they impact a person's ability to gain or continue work, the costs of sickness absence, presenteeism and job loss, and the positive impact of work on wellbeing. Sources of data: Scientific literature, mainly systematic reviews and grey literature, i.e. publications not accessible through medical databases. Areas of agreement: CMD are a major cause of disability, unemployment and dependency on welfare benefits. Good and healthy work is important for maintaining mental health and for promoting recovery from mental disorders. Areas of controversy: Evidence is limited with respect to the effectiveness of workplace interventions to prevent CMD and especially with respect to work outcomes and work reintegration of those who have been off sick. Growing points: There is growing interest in, and an increasing number of, best practice guidelines for employers, that could be improved and shared more actively. Areas timely for developing research: There is need for high-quality studies of interventions that examine work outcomes in patients who have been unable to obtain or continue work because of CMD.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Saúde do Trabalhador , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Humanos , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Serviços de Saúde do Trabalhador/economia , Retorno ao Trabalho/economia , Licença Médica/economia , Local de Trabalho
11.
Med Care ; 56(6): 520-528, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29668650

RESUMO

BACKGROUND: Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. OBJECTIVES: To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. RESEARCH DESIGN: Interrupted time series. SUBJECTS: In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. MEASURES: Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. RESULTS: After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. CONCLUSIONS: The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.


Assuntos
Dor Lombar/diagnóstico por imagem , Dor Lombar/economia , Imagem por Ressonância Magnética/economia , Doenças Profissionais/economia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Serviços de Saúde do Trabalhador/economia , Revisão da Utilização de Recursos de Saúde , Washington , Indenização aos Trabalhadores/economia
12.
BMC Public Health ; 18(1): 219, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402253

RESUMO

BACKGROUND: Recent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons', rehabilitation therapists' and employers' perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation. METHODS: Persons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists' experiences with working towards return to work within an ACT-approach and stakeholders' experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants' expectations and motivation for return to work. DISCUSSION: The outline of this comprehensive study could represent an important addition to the standard designs of return to work evaluation. The mixed methods design, with qualitative approaches as well as a rigorous randomized controlled trial, might prove useful to shed light on contextual factors. TRIAL REGISTRATION: ClinicalTrials.gov : NCT02541890 . September 4, 2015.


Assuntos
Transtornos Mentais/reabilitação , Doenças Musculoesqueléticas/reabilitação , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/métodos , Terapia Ocupacional , Adolescente , Adulto , Protocolos Clínicos , Análise Custo-Benefício , Economia Médica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/economia , Terapia Ocupacional/métodos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Projetos de Pesquisa , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Participação dos Interessados , Resultado do Tratamento , Adulto Jovem
13.
Workplace Health Saf ; 66(8): 373-383, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29384033

RESUMO

Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.


Assuntos
Enfermagem do Trabalho/organização & administração , Serviços de Saúde do Trabalhador/organização & administração , Saúde do Trabalhador , Assistência Centrada no Paciente/organização & administração , Adolescente , Adulto , Idoso , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Organizacionais , Serviços de Saúde do Trabalhador/economia , Satisfação do Paciente , Adulto Jovem
14.
BMC Public Health ; 17(1): 938, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-29241444

RESUMO

BACKGROUND: The increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers' willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work. METHODS: Three samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP. RESULTS: There was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27-43] in the general population sample, 32 €/month (95% CI: 26-38) in the T2D sample, and 55 €/month (95% CI: 43-71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay. CONCLUSIONS: For people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.


Assuntos
Comportamento de Escolha , Diabetes Mellitus Tipo 2/prevenção & controle , Emprego/economia , Serviços de Saúde do Trabalhador/economia , Adulto , Dinamarca/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Emprego/organização & administração , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade
15.
J Occup Environ Med ; 59(12): 1202-1210, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29023344

RESUMO

OBJECTIVE: To study the relationship between a biometric wellness data and future/actual medical costs. METHODS: A relationship between total cholesterol to high density lipoprotein ratio, blood pressure, and blood glucose and medical costs, based on analysis of claims data, was explored in 1834 employees that had both wellness program biometric and claims data in 2016. RESULT: Increased total cholesterol to HDL ratio is strongly associated with increased average costs (P < 0.01). Similarly, an increased glucose level is strongly associated with increased average costs (P = 0.001). There was no evidence of a relationship between elevated blood pressure and higher costs. CONCLUSIONS: By investing in an employer-sponsored biometric screening of full cholesterol and glucose profiles, medium-sized employers can identify high-risk employees who are expected to incur significantly higher healthcare costs, as compared with low-risk level employees, and improve treatment outcomes.


Assuntos
Biometria/métodos , Custos de Saúde para o Empregador/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Programas de Rastreamento/economia , Serviços de Saúde do Trabalhador/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia , Pressão Sanguínea , Feminino , Promoção da Saúde/economia , Humanos , Modelos Lineares , Lipídeos/sangue , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Adulto Jovem
17.
J Occup Environ Med ; 59(12): 1211-1220, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28953070

RESUMO

OBJECTIVE: The aim of this study was to evaluate cost-effectiveness of Acceptance and Commitment Therapy (ACT) and workplace dialogue intervention (WDI), both as stand-alone interventions and in combination, compared with treatment as usual (TAU), for employees on sickness absence with mental disorders. METHODS: Employees (n = 352, 78.4% females) on sickness absence were randomized to one of four groups. Cost-utility analyses were conducted from a health care perspective and a limited societal perspective. RESULTS: All groups reported significant improvements in health-related quality-of-life (HRQoL) and there were no significant differences in HRQoL or costs between groups. The probability of cost-effectiveness for ACT+WDI was 50% compared with ACT, indicating that both treatment alternatives could be considered equally favorable for decision-makers. TAU and WDI were rejected due to less economic efficiency. CONCLUSION: Adding WDI to ACT cannot be recommended on the basis of our study results.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde do Trabalhador/economia , Licença Médica/economia , Terapia de Aceitação e Compromisso/economia , Terapia Combinada/métodos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Serviços de Saúde do Trabalhador/métodos , Qualidade de Vida , Local de Trabalho
18.
BMC Public Health ; 17(1): 436, 2017 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-28494753

RESUMO

BACKGROUND: Common mental disorders (CMDs) are among the leading causes of sick leave in Sweden and other OECD countries. They result in suffering for the individual and considerable financial costs for the employer and for society at large. The occupational health service (OHS) can offer interventions in which both the individual and the work situation are taken into account. The aim of this paper is to describe the design of a study evaluating the effectiveness of an intervention given at the OHS to employees with CMDs or stress-related symptoms at work. In addition, intervention fidelity and its relation to the outcome will be assessed in a process analysis. METHODS: The study is designed as a cluster randomized trial in which the participating OHS consultants are randomized into either delivering the intervention or performing care as usual. Employees with CMDs or stress-related symptoms at work are recruited consecutively by the OHS consultants. The intervention aims to improve the match between the employee and the job situation. Interviews are held individually with the employee and the nearest supervisor, after which a joint meeting with both the employee and the supervisor takes place. A participatory approach is applied by which the supervisor and the employee are guided by the OHS consultant and encouraged to actively take part in problem solving concerning the work situation. Outcomes will be assessed at baseline and at six and 12 months. A long-term follow-up at 3 years will also be performed. The primary outcome is registered sickness absence during a 1-year period after study inclusion. Secondary outcomes are mental health and work ability. The intervention's cost effectiveness, compared to treatment as usual, both for society and for the employer will be evaluated. A process evaluation by both the OHS consultants and the employee will be carried out. DISCUSSION: The study includes analyses of the effectiveness of the intervention (clinical and economic) as well as an analysis of its implementation at the participating OHSs. Possible methodological challenges such as selection bias and risk of contamination between OHS consultants delivering the experimental condition and consultants giving usual care are discussed. TRIAL REGISTRATION: ClinicalTrials NCT02563743 Sep 28 2015.


Assuntos
Absenteísmo , Transtornos Mentais/terapia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/métodos , Licença Médica/economia , Transtornos Relacionados a Trauma e Fatores de Estresse/terapia , Local de Trabalho/psicologia , Adulto , Análise Custo-Benefício , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Suécia , Transtornos Relacionados a Trauma e Fatores de Estresse/economia , Local de Trabalho/economia
20.
Artigo em Inglês | MEDLINE | ID: mdl-28346379

RESUMO

Suicide and non-fatal suicide behavior (NFSB) are significant problems faced by most countries. The objective of this research is to quantify the economic cost of suicide and NFSB in the Australian workforce and to examine the potential impact of introducing a workplace suicide prevention intervention to reduce this burden. The analysis used the best available suicide data, a well-established costing methodology, and a proven workplace intervention. In 2014, 903 workers died by suicide, 2303 workers harmed themselves resulting in full incapacity, and 11,242 workers harmed themselves resulting in a short absence from work. The present value of the economic cost of suicide and NFSB is estimated at $6.73 billion. Our analysis suggests the economic benefit of implementing a universal workplace strategy would considerably outweigh the cost of the strategy. For every one dollar invested, the benefits would be in excess of $1.50 ($1.11-$3.07), representing a positive economic investment. All variations of the key parameter hold the positive benefit-cost ratio. Rates of suicide and NFSB are far too high in Australia and elsewhere. More needs to be done to reduce this burden. Although workplace strategies are appropriate for those employed, these interventions must be used within a multifaceted approach that reflects the complex nature of self-harming behavior.


Assuntos
Doenças Profissionais/economia , Doenças Profissionais/epidemiologia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/organização & administração , Ideação Suicida , Suicídio/economia , Suicídio/prevenção & controle , Local de Trabalho , Austrália/epidemiologia , Análise Custo-Benefício , Assistência à Saúde/economia , Depressão/complicações , Depressão/diagnóstico , Depressão/economia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Doenças Profissionais/psicologia , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Local de Trabalho/economia , Local de Trabalho/psicologia
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