Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL

Background: No universally accepted definition of multimorbidity (MM) exists, and implications of different definitions have not been explored. This study examined the performance of the count and cluster definitions of multimorbidity on the sociodemographic profile and health-related quality of life (HRQoL) in a general population. Methods: Data were derived from the nationally representative 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841). The HRQoL scores were measured using the Assessment of Quality of Life (AQoL-4D) instrument. The simple count (2+ & 3+ conditions) and hierarchical cluster methods were used to define/identify clusters of multimorbidity. Linear regression was used to assess the associations between HRQoL and multimorbidity as defined by the different methods. Results: The assessment of multimorbidity, which was defined using the count method, resulting in the prevalence of 26% (MM2+) and 10.1% (MM3+). Statistically significant clusters identified through hierarchical cluster analysis included heart or circulatory conditions (CVD)/arthritis (cluster-1, 9%) and major depressive disorder (MDD)/anxiety (cluster-2, 4%). A sensitivity analysis suggested that the stability of the clusters resulted from hierarchical clustering. The sociodemographic profiles were similar between MM2+, MM3+ and cluster-1, but were different from cluster-2. HRQoL was negatively associated with MM2+ (β: −0.18, SE: −0.01, p < 0.001), MM3+ (β: −0.23, SE: −0.02, p < 0.001), cluster-1 (β: −0.10, SE: 0.01, p < 0.001) and cluster-2 (β: −0.36, SE: 0.01, p < 0.001). Conclusions: Our findings confirm the existence of an inverse relationship between multimorbidity and HRQoL in the Australian population and indicate that the hierarchical clustering approach is validated when the outcome of interest is HRQoL from this head-to-head comparison. Moreover, a simple count fails to identify if there are specific conditions of interest that are driving poorer HRQoL. Researchers should exercise caution when selecting a definition of multimorbidity because it may significantly influence the study outcomes

Transitional safeguarding: Presenting the case for developing Making Safeguarding Personal for Young People in England

Purpose: The purpose of this paper is to set out the similarities and differences between the legal frameworks for safeguarding children and adults. It presents the case for developing a Transitional Safeguarding approach to create an integrated paradigm for safeguarding young people that better meets their developmental needs and better reflects the nature of harms young people face.  Design/methodology/approach: This paper draws on the key principles of the Children Act 1989 and the Care Act 2014 and discusses their similarities and differences. It then introduces two approaches to safeguarding: Making Safeguarding Personal (MSP); and transitional safeguarding; that can inform safeguarding work with young people. Other legal frameworks that influence safeguarding practices, such as the Mental Capacity Act 2005 and the Human Rights Act 1998, are also discussed.  Findings: Safeguarding practice still operates within a child/adult binary; neither safeguarding system adequately meets the needs of young people. Transitional Safeguarding advocates an approach to working with young people that is relational, developmental and contextual. MSP focuses on the wishes of the person at risk from abuse or neglect and their desired outcomes. This is also central to a Transitional Safeguarding approach, which is participative, evidence informed and promotes equalities, diversity and inclusion.  Practical implications: Building a case for developing MSP for young people means that local partnerships could create the type of service that best meets local needs, whilst ensuring their services are participative and responsive to the specific safeguarding needs of individual young people.  Originality/value: This paper promotes applying the principles of MSP to safeguarding practice with young people. It argues that the differences between the children and adult legislative frameworks are not so great that they would inhibit this approach to safeguarding young people

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention

OBJECTIVE: Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers. METHODS: Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey. RESULTS: Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change. CONCLUSION: The provision of telephone support for self-administered interventions in this context appears warranted

A Systematic Review of Cost-of-Illness Studies of Multimorbidity

Objectives: The economic burden of multimorbidity is considerable. This review analyzed the methods of cost-of-illness (COI) studies and summarized the economic outcomes of multimorbidity. Methods: A systematic review (2000–2016) was performed, which was registered with Prospero, reported according to PRISMA, and used a quality checklist adapted for COI studies. The inclusion criteria were peer-reviewed COI studies on multimorbidity, whereas the exclusion criterion was studies focusing on an index disease. Extracted data included the definition, measure, and prevalence of multimorbidity; the number of included health conditions; the age of study population; the variables used in the COI methodology; the percentage of multimorbidity vs. total costs; and the average costs per capita. Results: Among the 26 included articles, 14 defined multimorbidity as a simple count of 2 or more conditions. Methodologies used to derive the costs were markedly different. Given different healthcare systems, OOP payments of multimorbidity varied across countries. In the 17 and 12 studies with cut-offs of ≥2 and ≥3 conditions, respectively, the ratios of multimorbidity to non-multimorbidity costs ranged from 2–16 to 2–10. Among the ten studies that provided cost breakdowns, studies with and without a societal perspective attributed the largest percentage of multimorbidity costs to social care and inpatient care/medicine, respectively. Conclusion: Multimorbidity was associated with considerable economic burden. Synthesising the cost of multimorbidity was challenging due to multiple definitions of multimorbidity and heterogeneity in COI methods. Count method was most popular to define multimorbidity. There is consistent evidence that multimorbidity was associated with higher costs

Presenteeism: Implications and health risks

Background: Presenteeism – or working while ill – is commonly seen as just an economic indicator of disease burden. Emerging evidence suggests it may best be conceptualised as a behaviour that has implications for the person and their employer, and one that can be clinically managed. Objective/s: This article presents an overview of the phenomenon of presenteeism in the workforce and its clinical implications. It focuses on evidence relevant to the management of day-to-day, short term decisions on whether an individual should go into work while sick or take a day or more of work absence. This discussion is separate to the management of compensation and return to work issues. Discussion: Certain patients will be at risk of presenteeism, even when absence may be clinically advisable, due to personal or job characteristics. Presenteeism behaviour has potential positive and negative consequences for the patient’s own health, their job performance and tenure and their workplace, and these should be weighed up when helping patients to manage their work responsibilities. As presenteeism behaviour can be a precursor to work disability, it is important to understand its clinical significance and how it might manifest in general practice, in order to identify early warning signs for future long term disability

Managerial understanding of presenteeism and its economic impact

Purpose: The economic impact of ill‐health in employed individuals is largely experienced via absenteeism‐related and presenteeism‐related productivity loss. Using cognitive interviewing, the purpose of this paper is to evaluate a recently published interview method by which managers determine key job characteristics and their relationship to the cost of acute and chronic illness‐related absenteeism and presenteeism in the workplace: the team production approach. Design/methodology/approach: Managers (n=20) from various industries in Australia completed the team production interview by telephone. Quantitative items measured replaceability, team production, time sensitivity of output and illness‐related absenteeism and presenteeism costs. Concurrent verbal probes followed five items which assessed the productivity impact of illness‐related presenteeism, identified as cognitively challenging. Findings: Content analysis of interview outputs examined cognitive processes underlying managers’ responses and revealed difficulties understanding and quantifying chronic illness and presenteeism. Difficulties were categorised as misunderstanding of key concepts/terminology, inability to provide answers due to lack of knowledge, difficulty applying questions/scenarios to employees/workplaces and miscellaneous problems. Practical implications: Interview modifications are proposed to address concerns of managers. These changes aim to minimise measurement error in future applications of the instrument and improve valuation of chronic illness and presenteeism in the workforce. Social implications: Improved understanding of chronic illness and presenteeism could enhance estimation of productivity loss recoverable via health management/promotion strategies and may increase managers’ willingness to implement such programs. Development of valuation methods in a manner acceptable to and informed by business leaders/employers ensures findings have “real‐world” value. Originality/value: To the authors’ knowledge, this is the first use of cognitive interviewing to identify sources of response error in a productivity evaluation method

Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms

Objectives: The aim of the study was to investigate whether different types of health promotion intervention in the workplace reduce depression and anxiety symptoms. Methods: A systematic review and meta-analysis of the literature was undertaken on workplace health promotion published during the period 1997–2007. Studies were considered eligible for inclusion if they evaluated the impact of an intervention using a valid indicator or specific measure of depression or anxiety symptoms. The standardized mean difference was calculated for each of the following three types of outcome measures: depression, anxiety, and composite mental health. Results: Altogether 22 studies were found that met the inclusion criteria, with a total sample size of 3409 employees postintervention, and 17 of these studies were included in the meta-analysis, representing 20 intervention– control comparisons. The pooled results indicated small, but positive overall effects of the interventions with respect to symptoms of depression [SMD 0.28, 95% confidence interval (95% CI) 0.12–0.44] and anxiety (SMD 0.29, 95% CI 0.06–0.51), but no effect on composite mental health measures (SMD 0.05, 95% CI -0.03–0.13). The interventions that included a direct focus on mental health had a comparable effect on depression and anxiety symptoms, as did the interventions with an indirect focus on risk factors. Conclusions: When the aim is to reduce symptoms of depression and anxiety in employee populations, a broad range of health promotion interventions appear to be effective, although the effect is small