The role of prevention in workers' compensation managed care arrangements.

Managed care's emphasis on restricting costs may interfere with its ability to assume a prevention orientation. The authors present models, derived from group health and workers' compensation, of successful incorporation of prevention into managed care arrangements.

Worker participation in occupational health programs: establishing a central role.

1. The changing nature of work is creating workplace organizations and psychosocial work environments that can be hazardous to worker health. 2. Occupational health professionals have operated within a narrow construct of worker health and safety that has failed to recognize and address the health impacts of hazardous work organizations. It is time to expand the purview of occupational health and safety to include issues of work organization, workplace stress, and worker participation. 3. Worker participation programs are in vogue and purport to give workers more control over their work environment. But look closely. How much control and participation do these programs really provide? 4. Occupational health professionals should be vocal advocates for meaningful worker participation programs, and vocal critics of sham programs designed simply to advance the productivity goals of management.

Use of state workers' compensation data for occupational carpal tunnel syndrome surveillance: a feasibility study in Massachusetts.

The purpose of this study was to determine the feasibility of using Massachusetts workers' compensation data for passive surveillance of occupational carpal tunnel syndrome (OCTS). Workers' compensation claims for OCTS (n = 358) and for possible cases of OCTS (n = 1,121) active during the first 6 months of 1989 were identified. The availability and distribution of demographic and employment descriptors were assessed. Medical records on a sample of the claims were reviewed to validate the diagnosis of OCTS. Age, gender, and occupation were available for less than 47% of the reported cases of OCTS. The majority (88%) of cases on whom medical record review was performed had a physician's diagnosis of carpal tunnel syndrome (CTS), and most of this group had confirmatory nerve conduction studies or electromyography. However, there were fundamental limitations to workers' compensation based disease surveillance in Massachusetts, including underascertainment of cases, potential ascertainment biases, delayed case reporting, limited access to specific diagnostic information, and incomplete and sometimes inaccurate information. These limitations are likely to be applicable in many, if not most, states and must be made clear in any analyses based on workers' compensation data.

Ethical issues in providing occupational health services.

In the rush to capture new segments of the health care market, occupational health services have become an attractive "product line" for some provider groups. However, providers may not appreciate the significant ethical dimensions of delivering occupational health services. The environment of the workplace gives rise to competing goals, interests, and expectations and creates thorny ethical issues for health care providers. It is important that providers develop a framework for recognizing and addressing these ethical issues and the influence of their own and other parties' values on their decision-making processes.

Is the medical community ready for worker notification?

Although the potential for early detection of disease has been of central importance in the evolution of worker notification policy and practice, it is not the only positive outcome of medical intervention. The provider-patient encounter also creates an important opportunity for patient-centered risk communication that may result in workplace modifications as well as lifestyle changes to reduce the likelihood of subsequent illness and injury--both work and nonwork related. At the same time, it may signal the beginning of a series of social, legal, and political actions that may have positive or negative consequences for notified workers. This article identifies several important roles for members of the medical community relating to worker and community notification programs and explores the readiness of health care professionals in assuming these roles. It is suggested that health care providers lack both the training and sociopolitical sensitivity needed for meaningful participation in the notification process. This article addresses possible short-term and long-term approaches to enhancing the readiness of health care providers and suggests that effective intervention with notified workers requires a willingness to step beyond the confines of the medical model.

Activities of occupational health professionals in academic environments.

We surveyed American and Canadian medical schools to assess the extent to which occupational health professionals provided services to their own institutions. Ninety-two of 155 schools (60 percent) responded to a mailed questionnaire. Forty-six (51 percent) of the respondents had an occupational health service distinct from an employee health service. Two thirds of the respondents provided occupational health services to business and industry. Such professionals based in nonclinical departments were more likely to provide educational and epidemiologic services for hospital employees than were professionals based in clinical departments. In those institutions with risk management, biohazards, or health and safety committees, less than one half of the occupational health professionals in those institutions were members of those committees. Five respondents felt that there were financial disincentives to providing occupational health services to their institution's employees. We conclude that academic-based occupational health professionals have inadequate input into the provision of such services at their own institutions.

Clinical industrial toxicology. An approach to information retrieval.

Exposure to hazardous chemicals often occurs in the workplace. Workers and health care providers may have little knowledge of the health effects of these substances. An algorithm was developed to outline a logical approach to toxicologic information retrieval. Printed material and information sources such as government agencies, manufacturers, unions, and poison control centers should be consulted as a first step. If additional information is needed, telecommunications systems provide access to online databases. Aspects of databases most likely to provide useful information on toxic exposures are described.

Teaching occupational health to medical students.

Occupational and environmental disease and injury are both widespread and preventable, yet their study has been traditionally neglected in undergraduate medical education. Because family physicians will encounter many working patients who are subject to varying degrees of risk as a result of their job, home, or community environment, family practice faculty must play an important role in teaching occupational and environmental health to medical students. Goals for the longitudinal integration of occupational and environmental health over the four-year curriculum include sensitizing students to the relationship between work and health, introducing and reinforcing the importance of the occupational and environmental history in patient care, integrating occupational and environmental health principles and examples with existing course work, and providing appropriate clinical, research, and didactic activities for interested students. Goal achievement will vary with the availability of curricular time and teaching faculty. Strategies for implementing occupational and environmental health curriculum in the face of these two variables are discussed.