Reducing the impact of unemployment on health: revisiting the agenda for primary health care

Unemployed individuals contact GPs more frequently but report lower satisfaction: results of the population-based DEGS1 and the GPCare-1 patient survey

Unemployment is associated with a variety of adverse health-related outcomes, yet little data on primary care services for this risk group exist. Using data from two surveys, we analyzed the frequency of GP contacts and patients' experiences with GPs comparing unemployed with employed individuals. Data of the German Health Interview and Examination Survey for Adults (DEGS1), a nationwide cross-sectional study (n = 8151), were analyzed regarding associations between employment status and the number of GP visits. The General Practice Care-1 study (GPCare-1), a cross-sectional questionnaire survey (n = 813), evaluated patients' communication with their GP. Data were collected from June to August 2020 in 12 teaching practices affiliated with our university. The statistical analysis included individuals of working age (18-64 years old) (DEGS1 n = 5659, GPCare-1 n = 587). In both studies, working age subpopulations were analyzed (DEGS1: n = 5659 of 8151, GPCare-1: n = 587 of 813). In DEGS1, the prevalence of unemployment was 6.5% (n = 372). Unemployed individuals had more GP contacts in the last 12 months (4.50 vs. 2.86, p < 0.001). In the GPCare-1 study, unemployed individuals (6.6%, n = 39) were significantly less satisfied with GP communication: enough space in consultations (42.9% vs. 60.3%, p = 0.043), feeling comfortable to address sensitive topics (44.1% vs. 65.9%, p = 0.010), problems taken very seriously by GP (48.6% vs. 70.6%, p = 0.007). Yet, they were more willing to accept GPs' help for psychosocial burdens (67.6% vs. 47.6%, p = 0.024). GPs should be aware that patients with unemployment wish more support to cope with their burdening situation.

Influence of health promoting lifestyle on health management intentions and behaviors among Chinese residents under the integrated healthcare system

Background

Health promoting lifestyle is an important influencing factor of individual health status. This study aims to assess the health promoting lifestyle of community residents in China, and explore its association with their health management intention and behaviors during the integrated healthcare system reform.

Methods

A total of 666 residents were recruited from six county level hospitals and 12 community health centers from July to August 2019 in Zhejiang Province, China. Health promoting lifestyle was measured by the Chinese version Health Promoting Lifestyle Profile-II scale (HPLP-II).

Results

The average total score of HPLP-II among our sample was 130.02±23.19. Among the six domains, interpersonal relationship had the highest average score (2.68±0.50), and physical activity scored the lowest (2.21±0.59). Total score of HPLP-II scale was negatively associated with being male (β = -0.13, p<0.01; Ref: female), positively associated with being students (β = 0.15, p<0.01; Ref: self-employed), and positively associated with a monthly per capita income of more than 8000 RMB (β = 0.15, p<0.01; Ref: less than 3000 RMB). The domain scores of HPLP-II were significantly correlated with residents’ health management intention and their behavior on following doctors’ advice or not.

Conclusions

The health promoting lifestyles of community residents in China are at moderate levels. Improving residents’ healthy lifestyle levels might be helpful for changing their health management intentions or behaviors.

The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016

BACKGROUND

Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake.

METHOD

HCV surveillance data were sourced from South Australia's Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source.

RESULTS

HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman's rho - 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006).

CONCLUSIONS

Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.

Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review

BACKGROUND

Job loss, debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects.

METHOD

We searched MEDLINE, Embase, The Cochrane Library, Web of Science, and PsycINFO (January 2016) for randomized controlled trials (RCTs) of interventions to reduce the effects of unemployment and debt on mental health in general population samples. We assessed papers for inclusion, extracted data and assessed risk of bias.

RESULTS

Eleven RCTs (n = 5303 participants) met the inclusion criteria. All recruited participants were unemployed. Five RCTs assessed 'job-club' interventions, two cognitive behaviour therapy (CBT) and a single RCT assessed each of emotional competency training, expressive writing, guided imagery and debt advice. All studies were at high risk of bias. 'Job club' interventions led to improvements in levels of depression up to 2 years post-intervention; effects were strongest among those at increased risk of depression (improvements of up to 0.2-0.3 s.d. in depression scores). There was mixed evidence for effectiveness of group CBT on symptoms of depression. An RCT of debt advice found no effect but had poor uptake. Single trials of three other interventions showed no evidence of benefit.

CONCLUSIONS

'Job-club' interventions may be effective in reducing depressive symptoms in unemployed people, particularly those at high risk of depression. Evidence for CBT-type interventions is mixed; further trials are needed. However the studies are old and at high risk of bias. Future intervention studies should follow CONSORT guidelines and address issues of poor uptake.

Percepção de homens idosos sobre saúde e os serviços primários de saúde

Objetivo: compreender a percepção de homens idosos acerca dos temas: “Saúde”, “Unidade de Saúde da Família” (USF) e “Grupos em Saúde”. Métodos: estudo exploratório-descritivo, de abordagem qualitativa, com amostra de conveniência. Para selecionar os participantes, utilizou-se uma lista elaborada pela equipe com os nomes dos homens idosos da área de cobertura da USF que utilizavam os serviços de saúde oferecidos pela unidade. Para a coleta de dados realizou-se entrevista semi-estruturada e os dados foram analisados de acordo com a Análise de Conteúdo Temática. Resultados: participaram desse estudo 11 homens idosos. Os entrevistados possuem um conceito ampliado de saúde, abordando aspectos biopsicossociais em suas descrições. Eles apresentaram um bom vínculo com a USF, frequentando-a para consultas e participação em grupos de prevenção e promoção. Os participantes referiram não se engajarem em tantas atividades preventivas quanto as mulheres. Avaliam os Grupos em Saúde como benéficos, com repercussões positivas para a saúde e para a vida. Alguns, no entanto, carregam modelos de grupos de outros contextos, principalmente do mundo do trabalho, os quais não coincidem com os modelos de Grupo em Saúde. Conclusão: os participantes, por serem idosos e terem maior disponibilidade de tempo e vínculo com a unidade, conseguiram se engajar em mais atividades de promoção e prevenção. Observa-se que a unidade de saúde e os grupos atuam como fatores protetores para essa população, favorecendo o cuidado e as relações socias. No entanto, percebe-se que fatores associados ao gênero ainda dificultam um melhor cuidado de saúde por parte de homens.

Non-employment histories of middle-aged men and women who died from alcohol-related causes: a longitudinal retrospective study

Background

Long-term patterning of non-employment among problem drinkers is poorly understood. We determined the level and timing of non-employment, and the relative contribution of various types of non-employment among middle-aged persons who died of alcohol-related causes.

Methods

We conducted a longitudinal retrospective register-based study of Finnish men and women aged 45–64 years who died of alcohol-related causes (n = 15 552) or other causes (n = 39 166) in the period 2000–07, or who survived (n = 204 422) until the end of 2007. We traced back the number of days in employment and non-employment for up to 17 years before death or before the end of the study period for the survivors.

Results

The majority (≥56%) of persons who died of alcohol-related causes were in employment up to ten years before death. Over the 17-year period before death, those who died of alcohol-related causes were in employment on average two years less (mean 6.3 years, 95%CI 6.2–6.4) than those dying of other causes (8.2, 8.1–8.3), and five years less than survivors (11.6, 11.5–11.7), when sex and age were adjusted for. The relative role of various types of non-employment differed markedly across the two mortality groups. Among those who died of alcohol-related causes, unemployment accounted for 54% of the total burden of non-employment, in comparison with 29% among those who died of other causes. In contrast, disability pension accounted for 41% of the total burden of non-employment among those who died of alcohol-related causes, but 65% among those who died of other causes.

Conclusions

The results indicate the feasibility of preventing movement out of employment among middle-aged men and women with severe alcohol-related harm, provided that they are identified early on during their working careers and offered effective interventions.

Work and wellness hand-in-hand: the role of the New Zealand PATHS program nurse in improving health and employment outcomes

PURPOSE

Providing Access to Health Solutions (PATHS) is a New Zealand primary care based interdisciplinary, intersectoral vocational rehabilitation program working with clients who are unemployed and have health challenges inhibiting employment. This study examined the contribution of the nurse working in the PATHS program.

METHODS

A case study approach included in-depth interviews of PATHs program clients, stakeholders, and a documentation review.

RESULTS

Five themes emerged from the triangulated data: assessment and planning, personal and systems advocacy, persevering to the goal, the nursing approach, and respecting timing.

DISCUSSION

Program stakeholders valued the nurse's role in client assessment, risk analysis, ongoing client monitoring, and client coaching. Clients valued the nurse's work in supporting health literacy, joint health planning, advocating for timely provision of health and lifestyle behavior services as well as supporting, coaching, and prompting.

CONCLUSION

These roles together with those of other PATHS team members have led to many clients successfully entering or re-entering employment.