Chronic Conditions Management at the Workplace

Priya Parekh, OTD, OTR/L, CEAS; and Marissa Marchioni, OTD, OTR/L, CEAS 11/01/2020

Parekh, P., & Marchioni, M. (2020). Chronic conditions management at the workplace. SIS Quarterly Practice Connections, 5(4), 30–33.

High quality workplace wellness programs are in essence health promotion programs designed to improve employee health through implementing lifestyle and behavior changes. According to the Centers for Disease Control and Prevention (CDC; 2016), workplace wellness is a coordinated and comprehensive set of health promotion and protection strategies implemented at the worksite. The U.S. Bureau of Labor Statistics’ 2016 report states there are 151 million working adults in the United States, and among those 133 million have a chronic condition. Chronic conditions are physical and mental conditions that last more than 1 year such as diabetes, heart disease, obesity, hypertension, anxiety, and arthritis, among others (CDC, 2019). The World Health Organization (2005) asserts that unhealthy diet, lack of physical activity, substance use disorders, and protracted stress are some of the risk factors for chronic conditions.

Chronic conditions have costs such as decreased productivity, increased health care use, and absenteeism (Schopp et al., 2015). Absenteeism is a term used when an employee is habitually and frequently absent from work (Collier, 2018). According to the CDC (2019), managing chronic conditions costs the health care system $3.3 trillion per year. Another study shows that absenteeism because of chronic conditions costs more than $2 billion each year (Asay et al., 2016).

Health-related employer costs and productivity burdens have generated a pressing need for interventions to promote employee health and well-being (Schopp et al., 2015). With advances in best practices, many health conditions can be prevented through changing behaviors and lifestyle (Hooker et al., 2018). Research reveals that companies that implement health promotion programs can effectively improve employee risk factors like blood pressure, cholesterol levels, body weight, physical activity, stress, tobacco use, and nutritional intake (White et al., 2015).

The benefits of well-designed, comprehensive programs are clear in their identified return on investment. For example, the Rand Wellness Program Study examined 10-year data from a Fortune 100 employer and examined the aspects of the employer’s wellness program. Interestingly, chronic condition management was responsible for generating $136 in savings per employee per month and reducing hospital admissions by 30%; lifestyle management was responsible for generating $6 in savings per employee, per month (Schaefer, 2015). Additionally, the National Institute for Occupational Safety and Health’s (NIOSH’s) Total Worker Health® program seminal research provides substantial evidence of the efficacy of multilevel worksite health promotion programs in terms of return on investment and health outcomes (NIOSH, 2012).

Role of Occupational Therapy in Workplace Wellness

Occupational therapists’ (OTs’) expertise in health promotion, wellness, and functional engagement in routines makes them well suited for workplace wellness. OTs play a critical role in this field through their holistic understanding of the dynamic relationships among people, their environment, and ADLs, and how these interactions influence one’s health and well-being (American Occupational Therapy Association, 2015; Morris & Jenkins, 2018). OTs can collaborate with employers and employees to determine goals important for the company, perform ergonomic evaluations to increase safety and reduce concerns stemming from the physical environment, assess individual’s abilities related to job demands and intervene as appropriate to improve work performance, and provide individual or group seminars regarding techniques to improve health and function with existing common health conditions (Canadian Association of Occupational Therapists, n.d.). Additionally, OTs can implement lifestyle interventions to make employees healthier and improve their productivity by focusing on lifestyle areas like stress, sleep, physical fitness, eating routines, and social participation (Asay et al., 2016; see Table 1). Another intervention is the Hierarchy of Controls (NIOSH, 2015; see Table 2), which can be easier to implement through in-house OTs by addressing the needs of employees with chronic conditions while collaborating with senior management to change the work environment. OTs can also offer work wellness services in outpatient and other settings.

Table 1. Occupational Therapy Performance Areas, Assessments and Interventions

Performance Area	Assessment Tools	Intervention
Self-regulation health management IADL	Beck depression inventory II (Beck et al., 1996) Generalized Anxiety Disorder 7 item scale (Spitzer et al., 2006) Perceived stress scale (Cohen et al., 1983)	Cognitive restructuring techniques Sensory strategies Mindfulness-based interventions Behavioral adaptations
Sleep	Epworth sleepiness scale (Johns, 1991)	Sleep hygiene techniques Environmental modification
Health management IADLs—physical fitness, healthy eating routines	Canadian Occupational Performance Measure (Law et al., 2014)	Time management techniques Establishing eating routines
Work	Work environment scale (Moos, 2008)	Flexible work schedules Ergonomic consultation Support groups Education seminars Work culture that supports wellness (i.e., resources available, walking meetings, movement breaks; NIOSH, 2012)
Social participation	Social Profile (Donohue, 2013)	Communication strategies Assertiveness training Role play

Table 2. Models of Intervention

Models	Description	Ways to Use the Models
Health promotion model and chronic conditions model (Mattke et al., 2014)	Using motivational interviewing to emphasize the importance of healthy eating, engagement in physical activity, stress, energy conservation, and sleep routines.	Analyze routines, behaviors, and habits.
Wellness model (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012)	Dynamic process of learning new life skills and making conscious choices toward a more balanced and healthier lifestyle.	Analyze which dimensions—physical, financial, emotional, social, environmental, intellectual, spiritual, and occupational—are affected and strategize to cope with the concerns.
Person–Environment–Occupation Model (Law et al., 1996)	Balancing all 3 components results in improved occupational performance, a healthy state of mind, and healthy body.	Analyze the interrelationship between the 3 factors to modify the respective components for better outcomes.
Hierarchy of Controls (NIOSH, 2015)	Comprised of 5 stages, going from least effective to most effective ways to intervene, which includes personal protective equipment, administrative controls, engineering controls, substitution, and elimination.	Example of the intervention: OT can encourage workers to take ergonomic breaks; collaborate with management to change meetings to “walking meetings”; post signs encouraging walking; substitute unhealthy food with healthy options and eliminate unhealthy food at office parties.
NIOSH Total Worker Health® program (NIOSH, 2012)	Emphasizes policies, programs, and practices to promote workers’ health through illness prevention and health promotion programs.	Conduct seminars, analyze company’s goals and work culture to implement different intervention models while adhering to management’s expectations.

Case Example

Jessica was a 35-year-old woman who worked as a project manager in a multi-national company. She was referred to occupational therapy after being diagnosed with Type 2 diabetes and anxiety disorder which was exacerbated by work-related stress. Jessica reported cognitive and emotional work demands, difficulty with time management, and decreased/absence of physical activity and leisure participation.

The OT completed Jessica’s occupational profile to gain insights regarding routines and behaviors in the workplace, her physical environment, and to understand the work culture. Jessica’s primary goals were to better manage her anxiety and diabetes by improving her time management, increasing participation in physical activity, and improving sleep. The OT administered the Canadian Occupational Performance Measure (COPM; Law et al., 2014) during evaluation and at the discharge session where she identified stress, physical activity, time management, leisure participation and sleep as her outcome measure areas. The COPM assesses a client’s perceived performance and satisfaction in self-selected daily activities. Scores range from 1 to 10, with higher scores indicating better performance and satisfaction.

Based on the Wellness Model (SAMHSA, 2012), the OT focused on physical, emotional, social, and vocational dimensions of wellness to create a balanced and healthier lifestyle that addressed Jessica’s concerns over a span of 12 weeks. The OT used cognitive behavioral techniques to combat Jessica’s cognitive distortions, and mindfulness to improve her nervous system response. Time management strategies like scheduling, organizing, and prioritizing helped Jessica improve her work structure and flow at the workplace, while at home it gave her slivers of time to increase participation in physical activity like going to the gym and running; and leisure activities like playing guitar and sketching. Keeping Hierarchy of Controls in mind, Jessica proactively started taking ergonomic breaks (personal protective equipment), used stairs instead of elevators (engineering control) furthering her participation in physical activity, conducted walking meetings (administrative controls) and substituted healthy food for the unhealthier options at her office meetings (substitution and elimination). By the end of 12 weeks, Jessica noted significant changes in her life and health conditions as evidenced in the COPM scores by an increase in the performance rating by 3.9 points and satisfaction rating by 5.4 points. A change in the COPM score of 2 or more points is considered clinically significant (Law et al., 2014). She lost 10 lbs as a result of increased physical activity, improved her time management, and reported incorporating anxiety/stress coping skills and increased participation in leisure activities, resulting in decreased anxiety.

Conclusion

Evidence suggests that unmanaged chronic conditions have a profound effect on an individual’s sense of occupational well-being because it disrupts their routines (Crespo et al., 2013). Routines structure our daily activities, which play a pivotal role in an individual’s health and well-being. OTs can use their expertise in health promotion, wellness, and functional engagement to help improve workplace wellness.

References

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Priya Parekh, OTD, OTR/L, CEAS, is a clinical occupational therapist at the University of Medical Sciences Arizona’s Lionel Holder Rehabilitation Clinic in Avondale, AZ. She can be reached at parekhp@umsaz.org

Marissa Marchioni, OTD, OTR/L, CEAS, is an Assistant Professor of clinical occupational therapy at University of Southern California, Chan Division of Occupational Science and Occupational Therapy in Los Angeles.