Fig. 25.1
Conceptual illustration of “absenteeism” and “presenteeism”
There are several assessment procedures for measuring patients’ work productivity. Those procedures share core assessment domains with each other. The major shared domains are worktime missed (absenteeism), quality of work (presenteeism), work load, and personal factors including social, physical, and emotional aspects. All evaluation methods have distinctive and unique characteristics (Table 25.1). The Stanford/American Health Association Presenteeism Scale (SAHAPS) and Work Limitation Questionnaire (WLQ) consider personal factors and consist of a large number of questions about personal factors compared to work productivity. Almost all assessment procedures can evaluate presenteeism. An assessment procedure should be chosen by considering its distinctive characteristics and practical utility.
Table 25.1
Assessment of work productivity
Assessment tool | Health factors | Attendance at work | Quality of work | Workload/Work productivity | Individual traits (social, physical, and mental) | Others | |
|---|---|---|---|---|---|---|---|
Work Productivity Short Inventory (WPSI) | General health Specific diseases | • | • | [23] | |||
Work Limitations Questionnaire (WLQ) | General health | • | • | • | • | Work environment | [24] |
World Health Organization Health and Work Performance Questionnaire | General health | • | • | • | • | [25] | |
Stanford Presenteeism Scale | General health | • | • | • | [26] | ||
Endicott Work Productivity Scales (EWPS) | General health | • | • | • | • | [27] | |
Health and Labor questionnaire (HLQ) | General health, care management | • | • | • | • | [28] | |
Mac Arthur Health and Performance Questionnaire (MHPQ) | General health, disease prevention, health management | • | • | • | • | • | [29] |
SF36 | General health, care management | • | • | • | [30] | ||
Stanford/American Health Association Presentation Scale (SAHAPS) | General health | • | • | • | [31] | ||
Work Productivity and Activity Impairment-General Health (WPAI-GH) | General health | • | • | • | [12] | ||
Work Productivity and Activity Impairment-Allergy Specific (WPAI-AS) | Care management | • | • | • | [13] |
25.3 The Impact of Dermatoses on Work Productivity or Classroom Activity
In Japan, work productivity of patients with allergic rhinitis was assessed by the Work Productivity Activity Impairment Questionnaire-Allergy Specific (WPAI-AS), which consists of nine brief questions to evaluate productivity in the workplace, classroom, and daily life [12–14]. The results showed that productivity in these patients was impaired in approximately 39% of their innate ability [15]. It was also reported that the productivity of these subjects with allergic rhinitis was improved after therapeutic intervention [15].
Dermatoses also affect patients’ performance in the workplace and classroom. Hand eczema is a representative dermatosis and has received the most attention as an occupational disease [14]. Urticaria also affects patients’ QOL because of its spontaneous development and symptoms [9, 16]. Meanwhile, psoriasis severely impairs a patient’s QOL because of its cosmetic effects and prolonged clinical course. Previously, work on impaired productivity in subjects with hand eczema, urticaria, and psoriasis was assessed by the Work Productivity and Activity Impairment Questionnaire (WPAI), and total work impairment percentages were 29%, 25%, and 15.5%, respectively [9, 11, 14, 17–19]. In urticaria patients, proper intervention with a less sedative antihistamine decreased the work impairment ratio, while sedative antihistamines failed to improve work productivity [9, 11]. Thus, the effect of treatment interventions on productivity in the workplace/classroom also should be investigated.
Itch is the major symptom of dermatoses and impairs patients’ productivity in the workplace and classroom. Previous articles evaluated work productivity in Japanese subjects with itchy dermatoses and found severely impaired work productivity and daily activity [10, 11]. In that assessment, subjects who complained of itch and who consulted the dermatology clinic of a university hospital were asked to complete the WPAI, a self-administered questionnaire, before and after 1 month of treatment. The impairment ratio was assessed in patients with eczema/dermatitis, urticaria, atopic dermatitis, pruritus cutaneous, prurigo, and psoriasis (see below).
25.4 Work Impairment Ratio in Subjects with Atopic Dermatitis
Figure 25.2 shows the baseline impairment ratio for each of the dermatoses. WPAI measurement represents the overall impairment of productivity in the workplace/classroom and overall daily activity. The degree of overall work impairment ratio was higher in subjects with atopic dermatitis, eczema/dermatitis, and urticaria. The loss of time from work was more apparent in subjects with urticaria than those with the other dermatoses. In that study, subjects with a steady job comprised only approximately 20% of all laborers, and the loss of time from work was approximately 1.8% of total working hours. Loss of time from work for subjects without a steady job was approximately 5.3% of their total working hours. These results indicated that the impact of itchy dermatoses, such as atopic dermatitis, on attendance to workplace may differ by employment status.
