How to Define the Content of a Job-Specific Worker's Health Surveillance for Hospital Physicians?

BACKGROUND: A job-specific Worker's Health Surveillance (WHS) for hospital physicians is a preventive occupational health strategy aiming at early detection of their diminished work-related health in order to improve or maintain physician's health and quality of care. This study addresses what steps should be taken to determine the content of a job-specific WHS for hospital physicians and outlines that content. METHODS: Based on four questions, decision trees were developed for physical and psychological job demands and for biological, chemical, and physical exposures to decide whether or not to include work-related health effects related to occupational exposures or aspects of health reflecting insufficient job requirements. Information was gathered locally through self-reporting and systematic observations at the workplace and from evidence in international publications. RESULTS: Information from the decision trees on the prevalence and impact of the health- or work-functioning effect led to inclusion of occupational exposures (e.g., biological agents, emotionally demanding situations), job requirements (e.g., sufficient vision, judging ability), or health effects (e.g., depressive symptoms, neck complaints). Additionally, following the Dutch guideline for occupational physicians and based on specific job demands, screening for cardiovascular diseases, work ability, drug use, and alcohol consumption was included. Targeted interventions were selected when a health or work functioning problem existed and were chosen based on evidence for effectiveness. CONCLUSION: The process of developing a job-specific WHS for hospital physicians was described and the content presented, which might serve as an example for other jobs. Before implementation, it must first be tested for feasibility and acceptability.

Improving Work Functioning and Mental Health of Health Care Employees Using an E-Mental Health Approach to Workers' Health Surveillance: Pretest-Posttest Study

BACKGROUND: Mental health complaints are quite common in health care employees and can have adverse effects on work functioning. The aim of this study was to evaluate an e-mental health (EMH) approach to workers' health surveillance (WHS) for nurses and allied health professionals. Using the waiting-list group of a previous randomized controlled trial with high dropout and low compliance to the intervention, we studied the pre- and posteffects of the EMH approach in a larger group of participants. METHODS: We applied a pretest-posttest study design. The WHS consisted of online screening on impaired work functioning and mental health followed by online automatically generated personalized feedback, online tailored advice, and access to self-help EMH interventions. The effects on work functioning, stress, and work-related fatigue after 3 months were analyzed using paired t tests and effect sizes. RESULTS: One hundred and twenty-eight nurses and allied health professionals participated at pretest as well as posttest. Significant improvements were found on work functioning (p = 0.01) and work-related fatigue (p < 0.01). Work functioning had relevantly improved in 30% of participants. A small meaningful effect on stress was found (Cohen d = .23) in the participants who had logged onto an EMH intervention (20%, n = 26). CONCLUSION: The EMH approach to WHS improves the work functioning and mental health of nurses and allied health professionals. However, because we found small effects and participation in the offered EMH interventions was low, there is ample room for improvement.

Developing a Best-Evidence Pre-employment Medical Examination: An Example from the Construction Industry

The Dutch construction industry has introduced a compulsory preemployment medical examination (PE-ME). Best-evidence contents related to specific job demands are, however, lacking and need to be gathered. After the identification of job demands and health problems in the construction industry (systematic literature search and expert meeting), specific job demands and related requirements were defined and instruments proposed. Finally, a work ability assessment was linked to the instruments' outcomes, resulting in the modular character of the developed PE-ME. Twenty-two specific job demands for all Dutch construction jobs were identified, including kneeling/squatting, working under time pressure, and exposure to hazardous substances. The next step was proposing self-report questions, screening questionnaires, clinical tests, and/or performance-based tests, leading to a work ability judgment. "Lifting/carrying" is described as an example. The new modular PE-ME enables a job-specific assessment of work ability to be made for more than 100 jobs in the Dutch construction industry.

Return to Work after an Acute Coronary Syndrome: Patients' Perspective

OBJECTIVES: To describe the time perspective of return to work and the factors that facilitate and hinder return to work in a group of survivors of acute coronary syndrome (ACS). METHODS: Retrospective semi-structured telephone survey 2 to 3 years after hospitalization with 84 employed Dutch ACS-patients from one academic medical hospital. RESULTS: Fifty-eight percent of patients returned to work within 3 months, whereas at least 88% returned to work once within 2 years. Two years after hospitalization, 12% of ACS patients had not returned to work at all, and 24% were working, but not at pre-ACS levels. For all ACS-patients, the most mentioned categories of facilitating factors to return to work were having no complaints and not having signs or symptoms of heart disease. Physical incapacity, co-morbidity, and mental incapacity were the top 3 categories of hindering factors against returning to work. CONCLUSION: Within 2 years, 36% of the patients had not returned to work at their pre-ACS levels. Disease factors, functional capacity, environmental factors, and personal factors were listed as affecting subjects' work ability level.

EBM E-learning: Feasible and Effective for Occupational Physicians in Different Countries

OBJECTIVES: Although evidence-based medicine (EBM) is a useful method for integrating evidence into the decision-making process of occupational physicians, occupational physicians lack EBM knowledge and skills, and do not have the time to learn the EBM method. In order to enable them to educate themselves at the time and place they prefer, we designed an electronic EBM course. We studied the feasibility and utility of the course as well as its effectiveness in increasing EBM knowledge, skills, and behaviour. METHODS: Occupational physicians from various countries were included in a within-subjects study. Measurements were conducted on participants' EBM knowledge, skills, behaviour, and determinants of behaviour at baseline, directly after finishing the course and 2 months later (n = 36). The feasibility and utility of the course were evaluated directly after the course (n = 42). RESULTS: The course is applicable as an introductory course on EBM for occupational physicians in various countries. The course is effective in enhancing EBM knowledge and self-efficacy in practising EBM. No significant effect was found on EBM skills, behaviour, and determinants of behaviour. After the course, more occupational physicians use the international journals to solve a case. CONCLUSION: An electronic introductory EBM course is suitable for occupational physicians. Although it is an effective method for increasing EBM knowledge, it does not seem effective in improving skills and behaviour. We recommend integrating e-learning courses with blended learning, where it can be used side by side with other educational methods that are effective in changing behaviour.

Facilitators and Barriers in the Use of a Checklist by Insurance Physicians during Work Ability Assessments in Depressive Disorder

OBJECTIVES: Depressive disorder (DD) is a complex disease, and the assessment of work ability in patients with DD is also complicated. The checklist depression (CDp) has recently been developed to support such work ability assessments and has been recommended for implementation in insurance medicine, starting with an analysis of the organisational and social contexts. The aim of this study was to identify the potential facilitators and barriers in the use of the CDp by insurance physicians (IPs) during work ability assessments of employees on sick leave due to DD. METHODS: A qualitative research was conducted based on semi-structured interviews. The participants were IPs with at least one year of work experience in performing work ability assessments. The interviews were audiotaped, transcribed and analysed qualitatively. RESULTS: Ten IPs (7 males, 3 females; mean 53 years) were interviewed. Important facilitators, which emerged for use of the CDp, were an oral introduction for colleagues and staff, support from management, valuing the increased transparency in work ability assessments with using the CDp, having adequate time for assessments as well as modification of the appearance (colour, plasticised form) and content (clarifying aspects of the examples) of the assessment tool. The fear of the loss of autonomy, lack of added value of the CDp, high workload, inadequate instructions and lack of time were mentioned as barriers. CONCLUSION: Adequate introduction to the use of CDp and the fear of the loss of autonomy of IPs need special attention in planning its implementation.

Feasibility and Acceptability of Workers' Health Surveillance for Fire Fighters

OBJECTIVES: The objective of this study was to test the feasibility and acceptability of a new workers' health surveillance (WHS) for fire fighters in a Dutch pilot-implementation project. METHODS: In three fire departments, between November 2007 and February 2009, feasibility was tested with respect to i) worker intent to change health and behavior; ii) the quality of instructions for testing teams; iii) the planned procedure in the field; and iv) future WHS organisation. Acceptability involved i) satisfaction with WHS and ii) verification of the job-specificity of the content of two physical tests of WHS. Fire fighters were surveyed after completing WHS, three testing teams were interviewed, and the content of the two tests was studied by experts. RESULTS: Feasibility: nearly all of the 275 fire fighters intended to improve their health when recommended by the occupational physician. The testing teams found the instructions to be clear, and they were mostly positive about the organisation of WHS. Acceptability: the fire fighters rated WHS at eight points (out of a maximum of ten). The experts also reached a consensus about the optimal job-specific content of the future functional physical tests. CONCLUSION: Overall, it is feasible and acceptable to implement WHS in a definitive form in the Dutch fire-fighting sector.