How managing chronic conditions keeps presenteeism at bay Featured

8:00pm EDT April 25, 2010

From diabetes to asthma, chronic conditions can have a negative impact on your employees’ lives if they’re not properly managed. Not only that, chronic conditions can sap the productivity of your employees.

“They can lead to people not performing at their best, or having to take time off from work, if they get into a situation where they can’t manage their symptoms in a work environment,” says Ronald A. Adams, MD, regional chief of internal medicine for Kaiser Permanente.

Today’s physicians do all they can to keep people with chronic illnesses as healthy and active as possible, but people still need help managing these disorders, which is where you, as an employer, come in.

Smart Business spoke with Dr. Adams about how employers can reduce the impact of chronic conditions in the workplace, while helping employees manage their conditions.

Why should an employer play a role in managing chronic conditions?

Consider a person who had a heart attack at age 45 and survived, but went on to develop heart failure. If that person is not on certain medications, the heart failure could go from an asymptomatic stage to a point where the person is short of breath, has swollen legs and is fatigued.

If one of your employees has all those symptoms and makes it in to work, do you think he will be functioning at his best? His condition will most likely lower his productivity. In other cases, that employee may stay home because he just doesn’t have the energy to function. This is understandable, but at the same time, you’ve got a business to run.

Your employee’s doctor wants to keep that person from progressing with heart failure, which is why certain medications are prescribed. If you help your employees stay on their medications and follow doctors’ orders, you’ll have a healthy and productive staff.

What are the key aspects of managing chronic conditions?

Let’s take diabetes, for example. It’s a chronic illness that requires a lot of care and precaution. People with diabetes have to monitor their blood sugars, take a host of medications, monitor their exercise routines and maintain healthy diets.

A doctor can provide guidance and education, but a person needs assistance after he or she leaves the doctor’s office. Simply going in for a checkup every couple months or so doesn’t work anymore. Many times, it’s hard to find improvement between one interval and the next. Therefore, many doctors are providing coaching and support between visits — and this support can be extended into the workplace.

By being able to manage their conditions, people can avoid events that complicate care, which sometimes leads to disability. If people don’t manage their diabetes well, they may wind up with vision or kidney problems, or ulcers in their feet or lower extremities.

These are downstream effects. If you don’t do the primary prevention by coaching people and managing illnesses at home and in their work environments, then disability may occur. As the cost of managing people’s care increases, their ability to manage themselves at home and in their work environments falls apart.

How can you affect what people do outside the doctor’s office?

One aspect is education. Doctors teach patients about their diagnoses, what they mean, how their conditions’ progression can be prevented, and what medications will help with them.

Then, an action plan is put in place for the person. The person is shown what to do and how he or she should care for the condition. If you help your employees stay on their action plans, they can continue productive, healthy lives, while maintaining their regular routines at home and at work. If they don’t follow the action plan, they could move into the symptomatic stage, which means they won’t always be able to function well at work. Then you have presenteeism — when workers are physically on the job, but, because of illness or other medical conditions, are not fully functioning — or even absenteeism.

How can employers help minimize the effects of their employees’ chronic conditions?

Employers need to enable and encourage employees to communicate with their doctors. As people have more and more chronic illnesses, those illnesses need to be monitored more frequently. Some of that monitoring may need to occur in the workplace.

One way to improve monitoring is a telephone visit in lieu of a traditional office visit. Telephone visits are an excellent way of avoiding the traditional office-focused medicine of the 20th century. With a telephone visit, an employee sets up an appointment, and within 20 minutes his or her doctor is on the phone.

Another option is secure messaging. Patients can send their doctors questions or report in on how they’re doing, so the physician gets an update on their condition and has the opportunity to provide additional guidance.

Methods such as these are convenient for your employees, and you benefit by having employees take care of their medical issues in minutes online or over the phone, as opposed to them taking time off to go to the doctor.

Another thing employers can do is create healthy work environments. What kind of vending machines do you have at your job site? Are you promoting sugary drinks or are you promoting healthy drinks? When you have meetings, are you promoting pizza, cake and cookies, or are you promoting healthy snacks such as fruit? Are you promoting a nonsmoking environment?

Once you’ve encouraged healthy eating behaviors, encourage your employees to exercise in some way. You could offer fitness classes at the work environment, or help employees pay for gym memberships.

Anything you can do to help your employees with their chronic conditions will only help you and the organization.

Ronald A. Adams, MD, is regional chief of internal medicine for Kaiser Permanente. Reach him at (216) 297-2519.