Occupational medicine: the case for reform

Development of an interprofessional task-based learning program in the field of occupational health: a content validity study

OBJECTIVE

One of the duties of the educational system is to provide situations in which students learn the tasks corresponding to their future careers in an interprofessional team. This study was designed to develop an interprofessional task-based training program.

METHODS

This was a curriculum development study conducted by content validity methodology in two stages: 1) 'framework development' which resulted in the creation of the framework items; and 2) 'evaluation of the framework' (judgment and quantification). The first stage consisted of task identification, generation of sub-tasks, and assimilation of items into a usable format. The second stage consisted of the judgment -quantification of the content validity of items and the framework. After that, the framework of the tasks of the occupational health team was finalized in the expert panel. After explaining the tasks, a matrix for task-expected roles in the occupational health team and a matrix for task-required skills to perform each task were developed. The next step determined the appropriate teaching and assessment methods for each task. Finally, an expert panel reviewed and approved the components of the interprofessional task-based training program.

RESULTS

Integrating the interprofessional education strategy with task-based learning was considered innovative in occupational health team training. In the development stage, 48 items were extracted, and then 35 tasks were generated in the step of identification of tasks. In the second step, 174 sub-tasks were developed. The tasks and sub-tasks were categorized into seven areas. After the stage of evaluation of the framework, 33 tasks were categorized into seven main areas, including "assessment and identification of workplace hazards" (n = 10), "control of occupational hazards" (n = 4), "determining the appropriate job position for each person" (n = 3), "occupational health examinations" (n = 6), "management of occupational/work-related diseases" (n = 5), "inter-organizational and inter-disciplinary relations, and legal judgment" (n = 3) and "education and scholarship in occupational health services" (n = 2).

CONCLUSION

The results of the present study can be used in developing the use of the interprofessional strategy and task-based training as two appropriate strategies for the purposeful development of learners' abilities in the fields involved in providing occupational health services in their future careers.

Practices and Attitudes of Michigan-Based Occupational Physicians Regarding Adult Immunization

OBJECTIVE

To assess practices and barriers regarding adult immunizations, among occupational and environmental physicians in Michigan.

METHODS

A 10-item multiple choice web based questionnaire was designed after reviewing the Centers for Disease Control and Prevention recommendations and the current literature on adult immunization standards.

RESULTS

Assessing immunization status is common practice for 62% of respondents. 92% of respondents recommend the annual influenza vaccination, unless contraindicated. The most commonly reported barriers included the cost of providing immunizations and the prioritization of acute over preventative care. Use of standing order vaccinations and reminder-recall systems were popular strategies used to improve vaccination rates.

CONCLUSIONS

Occupational physicians frequently recommend influenza, tetanus, and hepatitis B vaccines when indicated, but are less likely to order other vaccines for patients. Promotion of a more comprehensive assessment of immunity needs in the workplace may improve national vaccine coverage.

Occupational and Environmental Medicine in the United States: A Proposal to Abolish Workers' Compensation and Reestablish the Public Health Model

The workers' compensation model of occupational and environmental medicine should be converted to a public health model. Occupational and environmental medicine, as a part of the public health infrastructure,could play a much more substantive part in bringing about a national program to deal with occupational and environmental health. The workers' compensation insurance system could be discontinued at any time,but it will be vital to do so when national health insurance is adopted in the United States. Abolishing workers' compensation would remove the perverse incentives that currently undermine the practice of occupational medicine. Medical care for workers should be provided by health care professionals who are not subject to influence by employers or insurers. Eligibility for benefits should not be determined by health and safety professionals. Wage-replacement benefits for workers should be determined by guidelines established by government and industry that prevent manipulation of health and safety professionals by employers and insurers. A nationwide comprehensive system to track work-related injury and illness, superior to the current reliance on records provided by employers and collated by government agencies, should be adopted. When unusually high rates of injuries, illnesses,and fatalities occur, government inspectors ought to respond and regulate the industry accordingly. Occupational health and safety professional strained in public health can and should participate in these activities, but not when they are in the employ of industry or insurers.

Excess healthcare costs associated with prior workers' compensation activity

BACKGROUND

Workers compensation (WC) does not fully compensate workplace injuries and illnesses. This work examines whether cost shifting occurs to group health insurance for work-related injuries and illnesses.

METHODS

Thomson Reuters MarketScan databases of medical insurance claims were used. WC and other benefit system data, employee status and types of medical insurance coverage were also available. Medical cost was analyzed using two-part models: the first part modeled the monthly probability of a worker having any group health medical claims, and the second part modeled the total monthly cost of those medical claims. Models included an estimate of a worker's annual medical costs prior to a WC claim. The predicted monthly medical costs were derived by retransformation using Duan's smearing factor.

RESULTS

Individuals with prior WC claims were more likely to file a group health medical claim compared to those with no prior WC claims (OR = 1.25) and incurred a higher average monthly medical costs (among nonunion hourly men aged 18-34 years with prior WC claims: $203.72 vs. $160.29 with no prior claim, an increase of $43). These increases were observed in all industrial sectors with the service sector having the highest monthly increase ($66).

DISCUSSION

The results reveal that individuals with prior WC claims had higher probability of filing a group health medical claim and higher average monthly medical costs in all sectors. This suggests that a part of employer liability costs related to WC gets shifted to the group health medical insurance system.

How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting

PURPOSE

Canada has a long tradition of involving employee representatives in developing work reintegration policies and expects this to positively affect employee involvement to improve work reintegration success. The purpose of this study was to examine employee involvement in reintegration in a Canadian province as experienced by employees.

METHOD

Fourteen semi-structured interviews were held with employees in a healthcare organization. The interview topic list was based on a review of local reintegration policy documents and literature. Interviews were transcribed verbatim and analysed using ethnographic methodology.

RESULTS

Employees do not feel in control of their reintegration trajectory. In the phase of reporting sickness absence, they wrestle with a lack of understanding on how to report in sick. In the phase of reintegration planning and coordination, they hesitate to get involved in the organization of reintegration. In the phase of reintegration plan execution, employees encounter unfulfilled expectations on interventions.

CONCLUSION

Employee involvement in the organization of reintegration makes them responsible for the development of reintegration trajectories. However, they consider themselves often incapable of completing this in practice. Moreover, employees experience that their contribution can boomerang on them.

IMPLICATIONS FOR REHABILITATION

• It is not that employees are not able to think along or decide on their reintegration trajectory but rather they are expected to do so at times when they cannot oversee their illness and/or recovery trajectory. • Settings out reintegration procedures that are inflexible in practice do not recognize that employee involvement in work reintegration trajectories can develop over time. • The disability management professional has a central role in organizing and supporting employee involvement in work reintegration, however, the employees do not experience this is indeed happening.

Evaluation of a workplace disability prevention intervention in Canada: examining differing perceptions of stakeholders

INTRODUCTION Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders see as the causes of work disability, what the intervention should aim at to address this problem, and to what extent the intervention works in practice. METHODS A qualitative research method was used, including data-triangulation: (a) documentary materials; (b) semi-structured interviews with the deliverers and workers (n = 14); (c) participatory observations of group meetings (n = 6); (d) member-checking meetings (n = 3); (e) focus-group meetings (n = 2). A grounded theory approach, including some ethnographic methodology, was used for the data-analysis. RESULTS Stakeholders' perceptions of causes for work disability differ, as do preferred strategies for prevention. Designers proposed work-directed measures to change the workplace and work organizations, and individual-directed measures to change workers' behaviour. Deliverers targeted individual-directed measures, however, workers were mostly seeking work-directed measures. To assess how the intervention was working, designers sought a wide range of outcome measures. Deliverers focused on measurable outcomes targeted at reducing work time-loss. Workers perceived that this intervention offered short-term benefits yet fell short in ensuring sustainable return-to-work. CONCLUSION This study provides understanding of where discrepancies between stakeholders' perceptions about interventions come from. Our findings have implications for workplace disability prevention intervention development, implementation and evaluation criteria.

Towards integration of environmental and health impact assessments for wild capture fishing and farmed fish with particular reference to public health and occupational health dimensions

The paper offers a review and commentary, with particular reference to the production of fish from wild capture fisheries and aquaculture, on neglected aspects of health impact assessments which are viewed by a range of international and national health bodies and development agencies as valuable and necessary project tools. Assessments sometimes include environmental health impact assessments but rarely include specific occupational health and safety impact assessments especially integrated into a wider public health assessment. This is in contrast to the extensive application of environmental impact assessments to fishing and the comparatively large body of research now generated on the public health effects of eating fish. The value of expanding and applying the broader assessments would be considerable because in 2004 the United Nations Food and Agriculture Organization reports there were 41,408,000 people in the total ‘fishing’ sector including 11,289,000 in aquaculture. The paper explores some of the complex interactions that occur with regard to fishing activities and proposes the wider adoption of health impact assessment tools in these neglected sectors through an integrated public health impact assessment tool.

Occupational Medicine Physicians in the United States: Demographics and Core Competencies

OBJECTIVE

We assessed the demographic profile and opinions of current occupational medicine (OM) physicians on the importance of specific core competencies.

METHODS

A random sample of 1500 OM physicians listed in the membership directory of the American College of Occupational and Environmental Medicine (ACOEM) were asked to complete a voluntary survey.

RESULTS

Six hundred and ten OM physicians completed the survey. Fifty two percent worked in clinical settings, and 16% worked in corporate or industrial settings. Eighty percent were satisfied with their choice of careers.

CONCLUSIONS

OM physicians appeared to be highly trained, with 60% certified in OM and 68% board certified in other specialties. The OM physicians valued staying current in the field, understanding the relationship between occupational exposure and health, and communicating with stakeholders most highly. Occupational physicians are an important source of knowledge regarding what competencies and core knowledge areas are important for OM practice.