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The relationship between lifestyle-, occupational health and work-related factors with presenteeism amongst general practitioners a

Sabrina Pit & Vibeke Hansen

a

a

University Centre for Rural Health, Sydney School of Public Health, THE UNIVERSITY OF SYDNEY Accepted author version posted online: 18 Feb 2015.

Click for updates To cite this article: Sabrina Pit & Vibeke Hansen (2015): The relationship between lifestyle-, occupational health and workrelated factors with presenteeism amongst general practitioners, Archives of Environmental & Occupational Health, DOI: 10.1080/19338244.2014.998329 To link to this article: http://dx.doi.org/10.1080/19338244.2014.998329

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The relationship between lifestyle-, occupational health and work-related factors with presenteeism amongst general practitioners

Downloaded by [University of Sydney] at 23:03 27 February 2015

Running title: Presenteeism amongst general practitioners

Sabrina Pit

University Centre for Rural Health, Sydney School of Public Health, THE UNIVERSITY OF SYDNEY

Vibeke Hansen

University Centre for Rural Health, Sydney School of Public Health, THE UNIVERSITY OF SYDNEY

Correspondence to: Sabrina Pit University Centre for Rural Health, THE UNIVERSITY OF SYDNEY, 61 Uralba Street, PO Box 3074, Lismore, NSW 2480, Australia

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ACCEPTED MANUSCRIPT Fax: +61 2 6620 7270 Email: [email protected]


Abstract

There is evidence that GPs are more likely to exhibit sickness presenteeism than other health professional groups or other high-income earners and less likely to take sick leave. This study aims to examine the relationship between lifestyle, occupational health and work-related factors with presenteeism amongst general practitioners (GPs). A cross-sectional study was conducted amongst GPs in 2011. Logistic regression was used to determine crude and adjusted odds ratios between lifestyle-, occupational health and work-related factors with presenteeism. Whilst adjusting for age and gender, exercising one to three times a week (odds ratio (OR) 4.88), not having a good work-life balance (OR 4.2), work-related sleep problems (OR 2.55), moderate psychological distress (OR 3.94) and poor or fair health (OR 6.22) were associated with presenteeism. Increased burnout and reduced job satisfaction and workability due to the physical demands of the job were also associated with presenteeism. In conclusion, presenteeism amongst GPs can be addressed by implementing interventions in relation to physical activity, stress reduction, sleep hygiene and improving work-life balance and the physical demands of the job.

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Introduction Previous studies have demonstrated that obesity, alcohol intake and physical activity1) are related to early retirement intentions 2,3) health 4), presenteeism5) workability and productivity6) in the


general population.

There are various definitions of presenteeism which can lead to confusion7. The preferred definition used by Johns is “attending work while ill”. However, it can be argued that coming to work while sick is only part of presenteeism. An equally important part is degradation in performance due to (usually not-serious) illness and discomfort ( eg due to a headache). Hence, others define presenteeism as “reduced productivity at work due to health problems and/or other events”5 7). Johns argues that framing presenteeism from this perspective is the intersection of medicine and economics. By using this definition, it is implicitly implied that going to work whilst sick leads to productivity loss, whilst there might be a productivity gain when compared to being completely absent. If the worker chooses to be absent the productivity loss could be higher. Additionally, going to work whilst sick might be viewed as being a good organisational citizenship. Johns reasons that whilst the definition that includes productivity loss includes the consequences of working whilst sick, it is just as important to understand the factors that explain presenteeism due to ill-health. Therefore, and in line with several other research conducted in the field of presenteeism 7 8), in this study, presenteeism is defined as “having gone to work despite feeling that one really should have taken sick leave due to one’s state of health”.

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Some research has been conducted in the area of presenteeism amongst health professionals 9). A recent systematic review concluded that there is preliminary evidence that workplace health promotion programs can positively affect presenteeism and that particular risk factors such as being overweight, a poor diet, a lack of exercise, high stress, and poor work-relations are


important predictors of presenteeism10). Another systematic review concluded that certain employee population groups have been more researched in the presenteeism literature than others, such as nurses5). Studies amongst doctors are less common. It should be noted that for GPs, there can be a reluctance to take time off, for reasons of practice disruption, availability for emergencies, and patient expectations. This is distinctively different from taking a day off due to sickness in an office environment. One study showed that the prevalence of presenteeism over a 12 month period amongst medical doctors was 49% and that they were the only occupational group that had high odds of presenteeism compared to other high income groups. Usually only lower income groups exhibit high presenteeism8). Another study demonstrated that 57% of physician residents reported working while sick at least once, and 31% reported working at least twice whilst sick in the previous 12 months11). Another study found that 37% of health care professionals reported that during the preceding 4 weeks, they had gone to work despite the feeling that they should have taken sick leave12). Ill health is the strongest predictor of presenteeism 4).. High presenteeism leads to depersonalisation and exhaustion (dimensions of burnout), and higher burnout leads to higher risk of leaving the workforce 13). It has also been suggested that presenteeism reflects work-related demands when an employee chooses to be present, even when ill, such as high time pressure and lack of resources14). This can in turn lead

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ACCEPTED MANUSCRIPT to increased healthy risk behavior because of job strain 9)..Hansen et al14) concluded that a relatively low explanatory power of combined factors to predict presenteeism suggests that there are still many unknowns in this field of research. Healthy lifestyle factors is one group that has not as yet been investigated in detail5, especially amongst health professionals.


In summary, there is a paucity of studies investigating the relationship of lifestyle factors and work-related factors with presenteeism amongst GPs. A conceptual framework has been developed to explore the concept presenteeism ( Figure 1). This study aims to examine the relationship between lifestyle, occupational health and work-related factors with presenteeism amongst general practitioners (GPs).

Methods

The Northern Rivers General Practice Network (NRGPN) is the local body representing GPs in the Northern Rivers region of NSW, Australia. A total of165 NRGPN members who were involved in any GP related work, were aged 45 and over or for whom date of birth was unknown received a study package from NRGPN containing a covering letter from the NRGPN, a participant information sheet, the anonymous survey, and a reply paid envelope. Completion of the survey was taken as consent to participate. The University of Sydney Human Research Ethics Committee approved the study.

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ACCEPTED MANUSCRIPT Outcome measure Presenteeism A slightly modified version of the item used by Aronsson et al8) was used to measure presenteeism: “Over the previous 12 months, how many days have you gone to work despite feeling that you really should have taken sick leave because of the state of your health?”. The


variable was dichotomised into two groups for the logistic regression: „0‟ and „1 or more days‟.

Independent variables Healthy lifestyle behaviour Body Mass Index (BMI) was calculated from self-reported heights and weights and classified according to the BMI categories recommended by the World Health Organisation (WHO) and is based on risk of co-morbidities 15).

Alcohol intake was measured by asking ”About how many alcoholic drinks do you have each week?” 16).

Physical activity was measured by a Single-item Physical Activity Measure17. This was the most suitable and validated single-item assessment developed: “In the PAST WEEK, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? (This may include sport, exercise, and brisk walking or cycling for

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ACCEPTED MANUSCRIPT recreation or to get to and from places, but should not include housework or physical activity that may be part of your job).”

Occupational health factors Burnout Downloaded by [University of Sydney] at 23:03 27 February 2015

A single-item self-defined global burnout measure, developed by the authors, asked respondents to rate their current level of burnout on a scale from 0-10 (“not all burnt out” to “completely burnt out”). The scale has been validated by the authors. Work life balance Work life balance was measured by asking the question “ I have a good work-life balance” on a four-point scale ranging between „strongly disagree‟, disagree, „agree‟ and „strongly agree‟. Absence Absence was measured by asking the question: “Over the previous 12 months, how many days have you taken off because of your health?”. Job satisfaction A single-item self-defined global job satisfaction measure, developed by the authors, asked respondents to rate their current level of job satisfaction on a scale from 0-10 (“extremely dissatisfied” to “extremely satisfied”). Workability Most short versions of the Work Ability Index (WAI) still incorporate a 14-item disease list,

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ACCEPTED MANUSCRIPT which makes it unsuitable for the use in a quick survey amongst busy practitioners. The short version used here, has been developed through extensive testing against related concepts. The 3item version of the Work Ability Index, extensively validated by Mykletun and Furunes

18)

asked respondents to rate their current work ability; (a) on a scale from 0-10 compared to lifetime best, (b) with respect to physical demands, and (c) with respect to mental demands.


Work-related sleep problems A single item developed by the authors (“I can‟t sleep well because I think about work”) was rated on a 7 point Likert scale (“Never” to “Every day”).

Individual health factors

General Health The global health question from the SF-36 was included to measure self-rated general health19).

Psychological distress The 6-item Kessler Psychological Distress Scale (K-6) was included as a brief measure of nonspecific psychological distress and has strong psychometric properties

20)

.

Demographics and work characteristics Age, gender, type of practice, years in general practice, average number of hours worked per week (in direct patient contact) were measured.

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Statistical analyses Prevalence of healthy lifestyle behavior, occupational health, individual health and demographic and work factors were calculated. T-tests, Chi-square and Fisher Exact tests were used for


univariate analyses.

Logistic regressions were used to estimate crude odds ratios and odds ratios adjusted for age and gender to determine which factors were associated with presenteeism. Statistical analyses were conducted using SAS 9.3 (SAS Institute, Cary, NC, USA).

Results A total of 92 GPs completed the survey, representing a response rate of 59%. Presenteeism was reported by 66% of GPs. About one third of GPs reported presenteeism for more than 5 days. Mean age of the GPs was 51 (sd=10.7) years, 60% were male and 91% were in a group practice.

Physical activity, work-related sleep problems, general health, job satisfaction and poor workability in relation to the physical and mental demands of the job were associated with presenteeism ( Table 1).

Table 2 shows that the crude odds ratios for presenteeism were substantially increased for GPs who reported exercising 1-3 times a week, experiencing work-related sleep problems, suffering from moderate psychological distress and those who reported fair or poor health. Furthermore,

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ACCEPTED MANUSCRIPT those who reported increased burnout, reduced work satisfaction, increased physical and mental workability demands had higher odds of being present at work despite feeling that they should have taken sick leave because of the state of their health.

After adjustment for age and gender (Table 3), the majority of the results did not change except


that the effect of work-life balance on presenteeism now reached significance, whereas poor workability due to the mental demands of the job no longer was associated with GPs going to work whilst feeling sick. No significant associations were found with BMI and alcohol intake, absence, workability at its lifetime best, group practice and working hours per week.

Discussion

This study adds to the empirical evidence of presenteeism amongst general practitioners. Of the healthy lifestyle behaviours, only physical activity was associated with presenteeism. The odds of presenteeism increased substantially for GPs who reported exercising 1-3 times a week, not having a good work-life balance, work-related sleep problems, experiencing moderate psychological distress and for GPs who reported fair or poor health. Also, those who reported increased burnout, reduced work satisfaction and poor workability due to the physical demands of the job had higher odds of presenteeism.

About two third of GPs reported presenteeism which is slightly higher than that reported in other studies (49% for physicians8) and 57% amongst physician residents 11)). There are multiple

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ACCEPTED MANUSCRIPT explanations why GPs work when sick, including low replaceability8), patient demand, supervisory responsibility14), small businesses14), working non-standard hours14), rate of cooperation in the team14), high work ethic, and not wanting others to take on the workload21 22). Indeed, qualitative analyses of interviews conducted among the study sample showed that GPs place a high value on teamwork and on making a difference to their patients. Indeed, 99% of the


GPs in our study felt that they made a difference to their patients' lives. They also identified the demands of running a small business as adding a layer of complexity to a GP‟s working life 23). These factors are qualitatively different and play less of a role for people working in an office environment. Absence was not associated with presenteeism. This may be explained by the small sample or the relative low level of absence amongst the study sample. Only 4% had more than 7 days off in one year. Other studies amongst health care professionals found similar low absence rates amongst physicians and GPs24). For example, a study amongst Swedish health care workers found that physicians had no respiratory-related absence whereas other health care workers did25). McKevitt et all reported that GPs‟ barriers to not taking sick leave were not being able to arrange cover and their attitude towards their own health 24). The authors suggest that factors such as GPs‟ attitudes to illness and working conditions may lead to artificially low rates of absence. The authors concluded that it would be useful to design strategies that encourage and enable doctors to take sick leave, which might also improve the management of their own health. Our study may assist in determining which strategies might potentially be useful and which factors can be targeted. Although often GPs are not subject to supervisory management or organisational policies, this is an area that is worth investigating in future studies because the

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ACCEPTED MANUSCRIPT landscape of general practice is slowly changing to larger group practices and fewer solo practices.

BMI and alcohol intake were not associated with presenteeism in this study, whereas physical activity was. Presenteeism increased substantially for GPs who reported exercising 1-3 times a


week. This result is somewhat counter intuitive as we would expect that GPs who do not exercise at all would be more likely to experience presenteeism at work than those who exercise. The finding may have been by chance. We are unaware of any studies that measured the relationship between lifestyle factors and presenteeism amongst GPs. Schultz et al 5) found in their systematic review two studies that reported an association between physical activity and noted it was surprising that so few studies had measured presenteeism related to physical activity. Contrary to the systematic review, Robroek et al did not find a relationship between insufficient physical activity and presenteeism. Being overweight or obese was not statistically related to presenteeism in a study amongst airline and health care employees26) but in other employee populations obesity has been found to be related to presenteeism6).

Our study found that 95% of GPs who reported presenteeism were in group practices compared to only 83% in solo practices but this was not statistically significant. It is likely that solo practitioners have a greater sense of responsibility towards their patients because there is no one to replace them. Our measure was dichotimised into „solo‟ or „group practice‟ and did not include other team members such as practice nurses. This may explain why Rantanen11) et al

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ACCEPTED MANUSCRIPT found that number of colleagues was associated with increased presenteeism and this study did not. Additionally, the number of solo-practitioners in our study was small.

Mental factors appear to play a big role in presenteeism in terms of burnout, job satisfaction, psychological distress and work-related sleep problems in this study. Poor workability due to the


physical demands of the job was also associated with presenteeism whereas workability in relation to the mental demands of the job appeared to be slightly less salient after adjusting for age and gender. Additionally, work life balance played a role after we adjusted for age and gender. It is therefore possible that for GPs factors outside work play a role in presenteeism or that they do not allow mental demands of the job to impinge on their decision whether or not they should go to work, but that they do take into account the physical demands of the job when deciding to stay home or not due to ill-health. In line with our findings, decreased job satisfaction has been demonstrated to increase presenteeism amongst health professionals 12) as have reduced health26 and acute and chronic health problems 12). Mckevit et al 24) asked medical practitioners and other professionals: 'If you woke up in the morning with a streaming cold and a headache would you take the day off work?', 86% of GPs said „definitely not‟, whereas for junior doctors, consultants and other professionals respectively only 56%, 57% and 32% indicated that they would definitely not take the day off. A New Zealand study also found that doctors were more likely to exhibit sickness presenteeism than other health professional groups 21). This demonstrates the need to be careful when comparing presenteeism between different working groups even within the medical profession itself because it appears from the literature that medical practitioners, in particular GPs, are more likely to display presenteeism than other health

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ACCEPTED MANUSCRIPT professionals and other types of professionals. GPs reporting presenteeism had a higher prevalence of self-reported work-related sleep problems (68% vs 42%) then those who did not report presenteeism. Sleep problems have previously been found to be related to job control amongst Finnish physicians27).


Study limitations included self-report, not measuring productivity loss, social desirability, wanting to be seen as altruistic28), small sample size and not being able to distinguish between serious illness when being present at work. Care should be taken in generalising these findings to other medical groups.

Besides, physician's responsibility and reluctance to take time off due to ill-health, there are other possible interpretations. GPs may be more reluctant to take time off because of illness when there is no or inadequate back-up medical care in their community. Our study could not measure whether the reluctance on the part of GPs to take time off work was associated with a sense of responsibility to their own individual patients or to their work and role. Also, a study limitation was that our study could not distinguish between chronic disease and communicable disease. This distinction is important because GPs may feel a sense of responsibility for not exposing patients to communicable disease (e.g. colds or influenza) when they have them. Lastly, how much of the reluctance of GPs to take time off for their illness has to do with long lists and crowded appointment schedules that would be disrupted with last-minute changes due to minor illness was also not measured in this study.

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ACCEPTED MANUSCRIPT We therefore recommend that further research is conducted to investigate the relationship between presenteeism and the lack of back-up medical care in the community and the interplay between feeling responsible for patients and their own work or role. It would also be beneficial in future research to make a distinction between GPs reasons for not coming to work due to chronic diseases or communicable diseases ( eg cold or influenza) and to explore in more detail


the impact of long waiting lists and busy appointment schedules on presenteeism. Finally, we also recommend to include productivity loss or gain in future study designs.

Given the potential risks to patients, presenteeism should be reduced where possible. Asking about the factors that impact on presenteeism can result in crucial information for employers, occupational health practitioners and GPs making it possible to intervene in earlier stages to avoid presenteeism4. Medical associations can play an important role in this area. In conclusion, presenteeism amongst GPs may be addressed by implementing interventions in relation to physical activity, stress reduction, sleep hygiene and improving work-life balance and the physical demands of the job.

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4

Taloyan M, Aronsson G, Leineweber C, Magnusson Hanson L, Alexanderson K, Westerlund H. Sickness presenteeism predicts suboptimal self-rated health and sickness absence: a nationally representative study of the Swedish working population. PLoS ONE [Electronic Resource] 2012;7:e44721.

5

Schultz A, Edington D. Employee Health and Presenteeism: A Systematic Review. Journal of Occupational Rehabilitation 2007;17:547-579.

6

Robroek SJW, van den Berg TIJ, Plat JF, Burdorf A. The role of obesity and lifestyle behaviours in a productive workforce. Occupational & Environmental Medicine 2011;68:134-9.

7

Johns G. Presenteeism in the workplace: A review and research agenda. Journal of Organizational Behavior 2010;31:519–542.

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Aronsson G, Gustafsson K, Dallner D. Sick but yet at work. An empirical study of sickness presenteeism. J Epidemiol Community Health 2000;54:502-9.

9

Heponiemi T, Kouvonen A, Sinervo T, Elovainio M. Is the public healthcare sector a more strenuous working environment than the private sector for a physician? Scandinavian Journal of Public Health 2013;41:11-17.


10

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Jena AB, Baldwin Jr DC, Daugherty SR, Meltzer DO, Arora VM. Presenteeism Among Resident Physicians. JAMA 2010;304:1166-8.

12

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Demerouti E, Le Blanc PM, Bakker AB, Schaufeli WB, Hox J. Present but sick: a threewave study on job demands, presenteeism and burnout. Career Development International 2009;14:50-68.

14

Hansen CD, Andersen JH. Going ill to work--what personal circumstances, attitudes and work-related factors are associated with sickness presenteeism? Social Science & Medicine 2008;67:956-64.

15

World Health Organization (WHO). Global database on Body Mass Index. http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Date accessed: 15 January 2010.: World Health Organization (WHO) 2010.

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The Sax Institute. The 45 and Up Study. Study materials and publications. Study materials archive http://www.45andup.org.au 2007.

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Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med 2011;45:203-8.

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Mykletun RJ, Furunes T. Work Ability and the Work Ability House Towards a Multi-


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Kessler RC, Andrews G, Colpe LJ et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 2002;32:959-76.

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Bracewell L, Campbell D, Faure P et al. Sickness presenteeism in a New Zealand hospital. The New Zealand Medical Journal 2010;123.

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Dew K, Keefe V, Small K. „Choosing‟ to work when sick: workplace presenteeism. Social Science & Medicine 2005;60:2273-2282.

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Hansen V, Pit SW, Honeyman P, Barclay L. Prolonging a sustainable working life among older rural GPs: solutions from the horse's mouth. Rural & Remote Health 2013;13:2369.

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McKevitt C, Morgan M, Dundas R, Holland WW. Sickness absence and „working through‟ illness: a comparison of two professional groups. Journal of Public Health 1997;19:295-300.

25

Kim JL, Toren K, Lohman S et al. Respiratory symptoms and respiratory-related absence from work among health care workers in Sweden. Journal of Asthma 2013;50:174-179.

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Terry PE, Xi M. An examination of presenteeism measures: the association of three scoring methods with health, work life, and consumer activation. Population Health Management 2010;13:297-307.

27

Heponiemi T, Kouvonen A, Vanska J et al. The association of distress and sleeping problems with physicians' intentions to change profession: the moderating effect of job


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Jena AB, Press VG, Arora VM. Social desirability bias in self-rated presenteeism among resident physicians--reply. JAMA Internal Medicine 2013;173:166.

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ACCEPTED MANUSCRIPT Table 1: Prevalence of healthy lifestyle, occupational and individual health and work factors by presenteeism (N=92). Variable


Healthy lifestyle behaviour

All GPs

Presenteeism No

Yes

N=31

N=61

n

%

%n

%

0

15

17

26

12

1-3

41

45

23

57

4-7

35

38

52

32

Underweight/ normal weight

54

59

55

61

Overweight

30

33

39

30

Obese

8

9

7

10

0

16

18

19

16

1-7

45

49

52

48

8-14

20

22

13

26

14+

11

12

16

10

68

76

87

69

P-value

Physical Activity (days/ per week) 0.0072

Body Mass Index 0.63

No. of standard alcoholic drinks/ week 0.46

Occupational health I have good work-life balance (% agree/

20

0.07

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ACCEPTED MANUSCRIPT strongly agree) Absence 0

51

55

68

49

1-7

37

40

29

46

8+

4

4

3

5

Very good

44

48

61

41

Rather good

31

34

32

34

Moderate

15

16

7

21

Rather poor

2

2

0

3

Very good

24

26

42

18

Rather good

42

46

36

51

Moderate

25

27

23

30

Rather poor

1

1

0

2

Never

37

41

58

32

A few times a year to everyday

53

59

42

68

64

70

84

62

0.23


Workability physical demands 0.14

Workability mental demands 0.078

Work-related sleep problems 0.018

Individual health Kessler 6 ( Psychological distress) Low

21

0.09

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ACCEPTED MANUSCRIPT Moderate

20

22

10

28

High/ Very high

8

9

7

10

Excellent

20

22

32

17

Very good

26

29

39

24

Good

24

27

23

29

Fair

17

19

7

25

Poor

3

3

0

5

Gender: Male

55

60

61

60

0.91

Group practice

81

91

83

95

0.11

1.9

3.7(2.

0.0015

(2.1)

6)

8.2(1.5)

7.3


General health 0.05

Demographic and work factors

Occupational health Burnout (0 to 10)

Job satisfaction (0 to 10)

Mean (SD) 3.1(2.5)

7.5(1.9)

0.026

(2.0) Workability: Lifetime best (0 to 10)

8.1(1.4)

8.3(1.4)

8.0(1.

0.28

3) Physical demands (1 to 5)

1.7(0.8)

1.5(0.6)

1.9(0.

0.0098

9)

22

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ACCEPTED MANUSCRIPT Mental demands (1 to 5)

2.0(0.8)

1.8(0.8)

2.1(0.

0.042

7) Demographic and work factors Age


Years in general practice

Average hours/week in general practice

51(10.7)

20(12.4)

36 (13.8)

23

53

50

(13.4)

(8.9)

20

20(10.

(15.3)

7)

35(15.4

36(13.

)

0)

0.21

0.96

0.62

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ACCEPTED MANUSCRIPT Table 2: Crude odds ratios by age and gender of GPs healthy lifestyle, occupational and individual health and work factors for presenteeism (N=92).

Presenteeism Healthy

Physical Activity (days/ per

Crude OR

lifestyle week) Downloaded by [University of Sydney] at 23:03 27 February 2015

P

(95% CI)*

behaviour 0 1-3

4-7

1

-

5.55 (1.51 to

0.00

20.37)

98

1.36 (0.41 to

0.46

4.57) Body Mass Index Underweight/ normal weight Overweight/ obese

1

-

0.79(0.33 to

0.59

1.89) No. of standard alcoholic drinks/ week 0-14

1

-

14+

0.57(0.16 to

0.38

2.03) Occupationa Burnout (0 not burnt out, 10

24

1.39 (1.12 to

0.00

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l health

Presenteeism

P

extremely burnt out)

1.74)OR Crude

31

I have a good work life balance.

0.34(0.10 to (95% CI)*

0.07

1.11)


Absence 0 days

1

-

1+ days

2.17 (0.88 to

0.09

5.36) Job satisfaction (0 extremely dissatisfied, 10 extremely

0.71 (0.52 to

0.03

0.98)

4

0.83 (0.58 to

0.28

satisfied) Workability at its lifetime best (0 worst, 10 best)

1.17)

Workability- Physical demands

2.07 (1.10 to

0.02

3.89) Workability- Mental demands

1.86 (1.01 to

0.04

3.40)

5

1

-

2.92 (1.19 to

0.02

I can’t sleep well because I think about work Never A few times a year to everyday

7.16)

25

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ACCEPTED MANUSCRIPT Presenteeism Individual

Kessler 6 –Psychological

Crude OR

health

distress

(95% CI)*

Low


Moderate

High/ Very high

P

1

-

3.88 (1.03 to

0.04

14.6)

5

2.05 (0.38 to

0.40

10.97) General Health – poor/ fair

Work

Group practice

6.37(1.37 to

0.01

29.59)

8

0.27(0.06 to

0.08

1.21)

7

1.01(0.98 to

0.62

factors Average working hours per week

1.04)

* Odds ratio and 95% Confidence Intervals. ** Absence= number of days in last 12 months that GP has taken off because of their health

26

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ACCEPTED MANUSCRIPT Table 3: Adjusted odds ratios by age and gender of GPs healthy lifestyle, occupational and individual health and work factors for presenteeism (N=92). Presenteeism Healthy

Physical Activity (days/ per

P

OR (95% CI)*

lifestyle week) behaviour Downloaded by [University of Sydney] at 23:03 27 February 2015

0 1-3

4-7

1

-

4.88 (1.29 to

0.01

18.45)

9

1.37 (0.40 to

0.62

4.70) Body Mass Index Underweight/ normal weight Overweight/ obese

1

-

0.98(0.36 to

0.96

2.66) No. of standard alcoholic drinks/ week 0-14

1

-

14+

0.66 (0.15 to

0.58

2.91) Occupationa Burnout (0 not burnt out, 10 l health

extremely burnt out)

27

1.35 (1.09 to

0.00

1.68)

68

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ACCEPTED MANUSCRIPT Presenteeism I have a good work life balance

P

0.24(0.07 to 0.04 OR (95% CI)* 0.91)

Absence* 0 days

1

-

1+ days

1.90 (0.75 to

0.18


4.8) Job satisfaction (0 extremely dissatisfied, 10 extremely

0.74 (0.54 to

0.05

1.00)

1

0.88 (0.62 to

0.47

satisfied) Workability at its lifetime best (0 worst, 10 best)

1.25)

Workability- Physical demands

Workability- Mental demands

2.15 (1.12 to

0.02

4.14)

1

1.79 (0.96 to

0.07

3.33) I can’t sleep well because I think about work Never A few times a year to everyday

Individual

1

-

2.55 (1.01 to

0.04

6.5)

7

Kessler 6 –Psychological

28

ACCEPTED MANUSCRIPT

ACCEPTED MANUSCRIPT Presenteeism health

distress

OR (95% CI)*

Low Moderate

High/ Very high Downloaded by [University of Sydney] at 23:03 27 February 2015

P

1

-

3.94(1.00 to

0.05

15.55)

0

2.17(0.40 to

0.37

11.82) General Health – poor/ fair

6.22(1.31 to

0.02

29.48) Work

Solo practice

0.31(0.06 to

0.13

1.46) Average working hours per week

1.01(0.97 to

0.68

1.04)

* Adjusted odds ratio and 95% Confidence Intervals. ** Absence= number of days in last 12 months that GP has taken off because of their health.

29

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ACCEPTED MANUSCRIPT

Figure 1. Conceptual framework presenteeism

30

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