OCCUPATIONAL HEALTH OCCUPATIONAL HEALTH SERVICESSERVICES

Dr. Dalia El-ShafeiLecturer of Occupational

Medicine

The Occupational Health The Occupational Health ServicesServices

DefinitionModels of Delivery

O.H. TeamO.H. ElementsFuture Trends

Services entrusted with essentially preventive functions and responsible for advising employers, workers, and their representatives in the undertaking of the requirements for establishing and maintaining a safe and healthy working environment, which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers in light of their state of physical and mental health.

The ILO estimates that only 5-10% of workers in developing countries and 20-50% of those in industrialized countries have access to adequate OHSs.

Further, the levels of OHS coverage have not changed significantly

over the last 10 years.

Company-based & -owned Occupational Health Services

Group Occupational Health Services

Hospital- and Tertiary Center-based Occupational Health Services

Free-standing Occupational Health Clinics

Occupational Health Services Delivered by Primary Care Physicians

Occupational Health Services in Countries in Transition

Many of the eastern and central European countries

currently undergoing transition to a market economy in order

to join the European Union are moving from a policy that

focuses on workers' protection toward one of prevention and

health promotion in the workplace. Now working to develop a

standardized system, ensuring health and safety conditions in

the workplace.

Occupational Health Services in Developing Countries

Training and curricula for OH specialists:

o completed basic training in medicine and nursing, then advanced training in occupational medicine, industrial medicine, or public health, leading to certification in the relevant field.

o But there are a worldwide shortage of formally trained occupational physicians and most OHSs are provided by physicians and nurses not formally trained in OH.

o Unfortunately, very little time is spent covering this area in the general medical and nursing curricula of most countries. So, such clinicians supplement their knowledge of the field through continuing education provided by professional OH organizations, institutions of higher learning with OH faculty, and industry-sponsored conferences and meetings.

Preplacement or Fitness for Duty Examinations

A worker's first contact with a medical provider in the OHS.

Has replaced the pre-employment examination which

often was used to determine whether to make a job offer to a prospective employee. If medical problems were found, they were sometimes used as a reason for not hiring the individual. The preplacement examination, by contrast, is supposed to take place after a conditional job offer has been made and is sometimes therefore referred to as a post-offer examination.

The content of the preplacement medical examination is variable, evidence-based and related to the possible job exposures that an individual could encounter.

The four major components of pre-placement examination:

Treatment and Rehabilitation of Acute Injury and Illness

When diagnosing and treating an acute injury, the occupational medicine provider must consider a number of important issues in addition to those of

basic medical management.

Sentinel Case Detection

A sentinel event, indicating that a hazard exists in the workplace that is placing other workers at risk.

Taking an adequate history of the circumstances of the injury can provide some clues.

When a possible sentinel event is recognized, there may be

a need for a focused investigation, similar to an outbreak investigation performed for a communicable disease.

Surveillance Periodic Examinations (periodic medical surveillance)

While industrial hygiene measures and engineering controls are the best way to prevent illness or injury from an industrial hazard, medical surveillance to detect subclinical effects of a hazard represent one of the means of preventing serious adverse effects.

Often, employees may be exposed to more than one hazard and require a number of different examinations. Computerized record systems may assist in the tracking of such requirements and scheduling appropriate examinations.

Results of surveillance examinations (spirometry, audiogram) may require evaluation of longitudinal time trends for a particular condition.

Other Periodic Examinations Other medical indications to periodically evaluate a worker's

fitness for duty. Periodic examinations for safety-sensitive jobs such as mobile equipment operators and Federal Aviation Administration physicals are also performed on a regular basis.

The focus of such periodic examinations is not to remove an individual with a medical problem from the workplace, but rather to determine whether any existing impairments can be adequately accommodated without placing the worker and others (including the general public) at risk.

Many periodic examinations, if not mandated by OSHA, must be

offered to the worker on a voluntary basis. If such examinations are seen as opportunities for job disqualification, workers (especially those who need them most) may opt not to take part.

Ideally, these periodic examinations can result in early detection

of chronic conditions in time to allow for preventive interventions such as diet modification, exercise, and work hardening to take place, allowing a worker to remain productively and safely employed.

Disability Review and Return to Work

An employee's personal health care provider may have less experience in return-to-work issues and may inappropriately give a patient permission to return to work or restrict the patient from returning to work for an excessive amount of time. The OH provider, by contrast, should have sufficient knowledge of specific job requirements to make a more informed decision. Therefore, many companies have policies requiring all employees returning to work after a prolonged absence to have an evaluation at the OHS to determine whether they can safely return or require job restrictions and/or modifications.

There is some evidence that prolonged absence makes returning to work less likely, and therefore, early intervention can help ensure that employees can return to work (with work restrictions if necessary) as soon as it is feasible.

In certain cases, an employee may become totally disabled from returning to work. This is a difficult decision best made by the OH provider after consultation with human resources, relevant safety managers, job supervisors, and the patient themselves.

Health Promotion

Travel Medicine With increasing globalization, travel medicine is becoming an

important aspect of the services provided by a comprehensive OHS. The occupational provider offering travel medicine services must

keep abreast of country-specific recommendations and advisories, including quarantines and travel bans and restrictions due to disease outbreaks. (the Centers for Disease Control and Prevention website: http://www.cdc.gov)

Infectious diseases, including travelers' diarrhea, are some of the most common medical problems encountered by travelers.

The leading causes of travel-related mortality are trauma due to motor vehicle accidents and drowning.

Recordkeeping In addition to keeping a complete medical record and

adequately storing the results of baseline and periodic testing on employees, the OHS should have certain routine forms and reports.

Retention of Records Many of the OSHA standards mandate that records of

surveillance examinations and other medical evaluations be retained for at least 30 years after leaving employment.

Confidentiality of Records Although recent federal guidelines for privacy of medical

records outlined in the health insurance portability and privacy act (HIPPA) are focused on the general medical care setting rather than the occupational medicine setting, the OHS should uphold the same standards of privacy and confidentiality in services provided and the record of those services. It is especially important to prevent the release of medical information to an employer.

Future Trends in the Provision of Occupational Health Services