Employment problems and prospects for patients with inflammatory bowel disease.

Abstract

Executive, MerseysideŜ UMMARY A random sample of 170 patients (88 men) with chronic inflammatory bowel disease (75 ulcerative colitis) were first interviewed in 1978 about their employment status, problems at work, and influence of surgery. Surgery had been carried out on 120 and 53 had an ileostomy. After six years 144 (92%) ofthe 156 survivors replied to a follow up postal questionnaire. Of the initial sample, 122 (72%) were working and there were only three (1%) registered unemployed. After six years a similar proportion were working and only seven (5%) were unemployed. Continuity of employment was good with 57% in the same job. Changes in work because of health had been made by 72 patients mainly caused by bowel disease. After surgery 10% completely changed and 22% modified their work while a few had to retrain or retire. Panproctocolectomy and ileostomy resulted in more changes and longer time off work after surgery than colectomy and ileorectal anastomosis, with 35°% and 17% respectively off work after one year. Problems at work, in particular general malaise and arthritis were experienced by 34 (28%) patients. Fewer problems were experienced by patients with a stoma who also had less sickness absence than those without a stoma. Colleagues and employers were usually supportive although some patients encountered discrimination especially those with a stoma or working in the food industry. Few patients had been counselled on their work. In general employment prospects and time off work were good and employers should be encouraged to take an optimistic and supportive role. Doctors should consider that convalescence after surgery may be longer than they perceive and must provide better counselling for patients.The objective of surgical and medical management of patients with inflammatory bowel disease are to minimise morbidity and restore the individual to good health so that they can return to work. There have been few detailed studies, however, on the impact of chronic inflammatory bowel disease and treatment on employment. Two surveys of patients with Crohn's disease and another of patients with ulcerative colitis have shown that between 65 and 90% respectively were 'working' or 'fully employed'. ' 1 Similarly the formation of an ileostomy, as part of panproctocolectomy, has been shown to be followed by resumption of work in 85 to 95% of patients but in some series housewives were included as 'employed'.A More detailed information

Inflammatory Bowel Disease: Patients' Expectations in the 1990s

“…Yet most studies show that patients want more information-". Wyke et al 6 found advice on employment lacking in particular. They felt that although hospital specialists should give this information, shortage of time, changes of staff and the presence in clinics of relatively untrained juniors meant that gastrointestinal nurse counsellors may be the best solution to this problem.…”

A claims‐based Markov model for Crohn’s disease

“…However, if indirect costs were captured, the model would likely demonstrate an even greater increase in costs for each disease state as previous research has indicated that CD has a negative effect on employment, 24 and as disease severity increases, work absences increase and productivity decreases. 25 For example, a study of an international population of patients with moderate-to-severe active CD revealed that 39% were unemployed and 25% were receiving disability benefits. 26 In addition, a study by Lichtenstein et al 27 demonstrated that disease remission, measured using the Crohn's disease activity index, was associated with improvement in employment status and quality of life.…”

Difficulties at work experienced by patients with inflammatory bowel disease (IBD) and factors relevant to work motivation and depression

“…In Japan these disease are classified as nanbyou , a Japanese word that refers to 1 diseases without known causes and 2 diseases that place a continuous burden on the patient and his her family, not just in economic terms but also with regard to 2002 Wyke et al, 1988 , and that these differences are related to the presence or absence of their symptoms Longobardi et al, 2003 . Questions were designed to evaluate the frequency with which a patient experienced difficulties. Patients were asked to choose from one of the following 3 possible answers for each item never , sometimes , or often .…”