Occupational health care personnel tackling alcohol overuse – an observational study of work processes and patient characteristics

Background Overuse of alcohol is a significant risk factor for early retirement. This observational study investigated patient characteristics and work processes in occupational health care (OHC) affecting practices in tackling alcohol overuse. Methods The data were from 3089 patient contacts gathered for quality improvement purposes in fifteen OHC units during the years 2013–2019 in Finland. A two-proportion z-test was performed to find associations between reason for contact, and 17 other factors, and the probability of alcohol use being checked and overuse tackled. Results OHC personnel checked alcohol use twice as often with male patients as with female patients. Employees at risk of needing sick leave were checked for alcohol use more often (55.4, 95% confidence interval 49.2–61.6%) than those on > 30-day sick leave or working with permanent work disability (p < 0.01). Alcohol use was checked in 64.1% (59.5–68.7%) of patients while making an individual health promotion plan compared to 36.9% of those without a plan (33.1–40.6%, p < 0.0001). Patients with depression were actively checked for alcohol use, especially in cases of major depression (72.7%, 64.0–81.0%). Work processes in which OHC should have been more active in checking and tackling alcohol use included assessing the need for rehabilitation (36.5%, 32.0–41.0%) and health check-ups (HCUs) for mental reasons (43.8%, 38.1–49.4%). HCUs where alcohol overuse was detected led to brief interventions to tackle the overuse in 58.1% (43.4–72.9%) of cases. Conclusions The study showed factors that increased OHC personnel’s practices in checking and tackling alcohol use and work processes where the activity should be improved. Discussions about alcohol use took place more often with working-aged men than women, the younger the more. OHC personnel checked actively alcohol use with patients in danger of sick leave, patients treated for depression, while making an individual health promotion plan, and in planned HCUs with a confirmed protocol. More improvement is needed to conduct brief interventions in disability prevention processes, and especially when overuse is detected.

Yhteistoimijuus työterveysneuvottelussa

Eri toimijoiden välisen yhteistoimijuuden on todettu edesauttavan työuravaikutusten syntymistä. Työterveysneuvottelu on tärkeä työntekijän, työpaikan, työterveyshuollon yhteistyön ja kuntoutuksen yhteistyöfoorumi. Sen tavoitteena on tukea työntekijän työssä jatkamista ja työurien pidentymistä. Tässä artikkelissa tarkastellaan yhteistoimijuuden ilmenemisen tapoja sekä sen toteutumisen esteitä työterveysneuvottelussa. Tutkimus oli moniaineistoinen monitapaustutkimus. Neljäntoista tapauksen aineiston muodostivat työterveysneuvotteluun osallistuvien ennakkokysely ja neuvottelun jälkeinen haastattelu, neuvottelun videotaltiointi, neuvottelun muistio sekä kyseisen työpaikan työkyvyn tuen kirjalliset mallit. Moninäkökulmainen aineisto kerättiin neuvotteluun osallistuneelta työntekijältä, esihenkilöltä ja työterveyslääkäriltä sekä videotaltioinnin osalta kaikilta neuvotteluun osallistuneilta. Aineisto analysoitiin sisällön- ja keskustelunanalyysillä. Yhteistoimijuus ilmeni institutionaalisena, emotionaalisena, kommunikatiivisena ja supportiivisena ulottuvuutena. Institutionaalinen ulottuvuus ilmeni esimerkiksi toimijoiden roolien selkeytenä, emotionaalinen ulottuvuus kuulluksi tulemisena, kommunikatiivinen ulottuvuus yhteisenä päätöksentekona ja supportiivinen työntekijän tukemisena. Yhteistoimijuuden toteutumista estivät epäselvyys eri toimijoiden rooleista ja yhteisen näkemyksen tai yhteisen päätöksenteon puuttuminen. Kestävän työhönpaluun onnistumiseksi työntekijän toimijuutta tulisi tukea yhteistoimijuuden keinoin. Yhteistoimijuuden rakentumisen kannalta keskeistä oli tunnistaa työterveysneuvottelutilanne julkiseksi neuvotteluksi. Abstract Multi-actor shared agency at joint negotiations on the employee’s return-to-work Collaboration between workplace, health care and rehabilitation actors has been shown to contribute to the working career impact. Joint negotiations on the employee’s return-to-work solutions is one key forum for co-operation between an employee, workplace’s actors, and actors of occupational health care and rehabilitation services. The aim of this collaboration is to support job retention and to prolong working careers. This article discusses which forms of multi-actor shared agency took place and what kind of obstacles to collaboration were found in the joint negotiations on the employee’s return-to-work. The study was a multiperspective, multi-data study on multiple, altogether 14 joint negotiation, cases. Data on each case consisted of the questionnaire collected before the negotiation, the video-recorded data of the joint negotiation, three interviews after the negotiation, the negotiation memo and the workplace’s model of work ability support. The questionnaires and interviews were collected from employees, supervisors and occupational health physicians and video-recorded data was collected from all participants in the joint negotiation. The data was analyzed by a multidisciplinary research team with content and discussion analysis. Multi-actor shared agency was definable to institutional, emotional, communicative and supportive dimensions. New institutional dimension included elements of clarity of the roles of the actors. The emotional dimension included experiences of being heard and of confidentiality. The communicative dimension included elements of collaborative decision-making, and last, the supportive dimension included elements of employee’s support. The lack of clarity regarding the roles of the various actors, secondly, the lack of a shared target and collaborative decision-making prevented the realization of the multi-actor shared agency. In order to succeed in returning to work, the employee's agency should be supported by the multi-actor shared agency means. It was essential for the multi-actor shared agency to recognize that negotiations with workplace actors on return to work are held, instead of internal health care platforms, in a public platform. Keywords: agency, multi-actor shared agency, collaboration, work-related rehabilitation, joint negotiation, returning to work, vocational rehabilitation, occupational health care, multiple case study, qualitative research

Occupational health resource classification instrument (OHRCI) in the oil industry, Brazil

Background The study describes the development of the Occupational Health Resource Classification Instrument (OHRCI) aiming to classify the levels of occupational health care in the oil industry, Brazil, considering the aspects of prevention and health promotion. Methods OHRCI was developed by 6 recognized experts in occupational health management with at least 10 years of experience. For content validation, the Delphi Technique was used, with 20 specialists from the fields of medicine, dentistry, social work, nutrition and psychology participating in 40 meetings with an average duration of 2 hours each. All proposed adjustment recommendations were incorporated and accepted. Results OHCRI tool was structured. It considers the characteristics of the oil companies regarding the assessment of risk scenarios, location and exposed population, resulting in a score between 1 and 16. Nine levels of occupational health care were defined, which allows to objectively consider the dimension of the workforce and attendance modality. The results of OHCRI tool allow specific strategic actions in people management, related to the monitoring of work processes and adaptation of professional skills. Conclusions The proposed tool is considered validated and its application generates business value, ensuring the maintenance of resources for comprehensive health care and attendance level adequate to the needs of the oil industry and workers and associated compliance aspects.

Occupational health care in regions with different levels of occupational morbidity in agricultural workers

Introduction. In recent years, special attention has been paid to the discrepancy between working conditions in different sectors of the Russian economy and the inadequately low level of registered occupational morbidity (OM). At the same time, as a rule, issues of access to occupational health care that are important for the rural population are not considered due to the lower potential of socio-economic and infrastructural development of rural areas compared to the city. Material and methods. The paper uses updated data on 82 subjects of the Russian Federation on working conditions, the level of OM of agricultural workers, and indicators of occupational health care for the rural population in 2011-2017. Results. The ranking of subjects of the Russian Federation by the level of non-infectious occupational morbidity of agricultural workers was carried out: group I (OM above the national average), group II (OM below the national average), group III (OM is not registered). It is shown that non-detection of occupational diseases in the regions of group III could be due to insufficient provision of rural health care by occupational pathologists (54.2%), low coverage of workers with periodic medical examinations (PME) (76.6%), as well as the absence of occupational health centers (OPC) in 5 territories. of the 18 regions. According to the criteria of availability of occupational pathologists (97.5%) and coverage of PME (95.5%), the highest availability of primary occupational pathology care occurred in the regions of group II. However, the high proportion of occupational diseases identified during self-treatment indicated a formal approach to conducting PME in this group. The most accessible specialized occupational health care was typical for the subjects of the Russian Federation of group I with a high level of OM, on the territory of which the most significant number of OPC functioned with the possibility of extended pre-examination of employees with suspected occupational diseases in a hospital. Conclusion. Along with harmful working conditions, the occupational morbidity of agricultural workers is primarily determined by the availability of specialized occupational health care, namely, occupational health centers’ availability, equipment, and capacity.

Supporting employees with chronic conditions to stay at work: perspectives of occupational health professionals and organizational representatives

Background Supporting employees with chronic conditions can prevent work-related problems and facilitate sustainable employment. Various stakeholders are involved in providing support to these employees. Understanding their current practices and experienced barriers is useful for the development of an organizational-level intervention to improve this support. The aim of this study was to explore the current practices of occupational physicians and organizational representatives, identifying both barriers to providing support and opportunities for improvement. Methods Two focus groups with sixteen occupational physicians and seven semi-structured interviews with organizational representatives were held between January and June 2018. Data was analyzed using thematic content analysis. Results Several barriers to offer support were identified, including barriers at the organizational level (negative organizational attitudes towards employees with chronic conditions), the employee level (employees’ reluctance to collaborate with employers in dealing with work-related problems), and in the collaboration between occupational physicians and organizational representatives. In addition, barriers in occupational health care were described, e.g. occupational physicians’ lack of visibility and a lack of utilization of occupational physicians’ support. Opportunities to optimize support included a shared responsibility of all stakeholders involved, actively anchoring prevention of work-related problems in policy and practice and a more pronounced role of the health care sector in preventing work-related problems. Conclusions Preventing work-related problems for employees with chronic conditions can be achieved by addressing the identified barriers to provide support. In addition, both occupational physicians and organizational representatives should initiate and secure preventive support at the organizational level and in occupational health care. These insights are helpful in developing an intervention aimed at supporting employees with chronic conditions to stay at work.

Kuntoutukseen osallistuminen ja eri osajärjestelmien ristikkäiskäyttö

Tieto kuntoutuksen kentän kokonaisuudesta ja erilaisten kuntoutuspalveluiden käytöstä samoilla ihmisillä on varsin hajanaista ja puutteellista. Tutkimuksen tavoitteena on selvittää kuntoutukseen osallistumisen yleisyyttä ja päällekkäisyyttä eri osajärjestelmissä Oulun asukkailla vuonna 2018 laajalla rekisteriaineistolla (N = 192 844). Tutkimuksessa tarkastellaan julkisen sosiaali- ja terveyspalvelujärjestelmän kuntoutusta, Kelan kuntoutusta, työeläkekuntoutusta, työterveyshuollon fysioterapiaa ja Kelan korvaamaa yksityistä fysioterapiaa. Vuonna 2018 oululaisista 18 prosenttia sai vähintään yhden tutkitun osajärjestelmän kuntoutusta (N = 34 061). Yleisintä oli julkisen sosiaali- ja terveyspalvelujärjestelmän kuntoutus, harvinaisinta työeläkekuntoutus. Naiset osallistuivat kuntoutukseen miehiä yleisemmin. Kuntoutukseen osallistuminen oli miehillä yleisintä 65 vuotta täyttäneillä, naisilla 45–64-vuotiailla. Harvinaisinta se oli 16–24-vuotiailla miehillä ja alle 16-vuotiailla naisilla. Suurin osa (90 %) kuntoutukseen osallistuneista oli osallistunut vain yhden osajärjestelmän kuntoutukseen. Useamman osajärjestelmän kuntoutukseen osallistuminen oli naisilla miehiä yleisempää. Ikäryhmistä se oli yleisintä 45–64-vuotiailla ja harvinaisinta alle 16-vuotiailla. Vähintään kahden osajärjestelmän kuntoutukseen osallistuneet olivat keskimäärin vanhempia kuin vain yhden osajärjestelmän kuntoutukseen osallistuneet ja myös naisten osuus oli heillä suurempi. Rekisteritietoja kuntoutuksesta on hankala koota kattavasti, sillä järjestelmä on hyvin hajanainen ja toimijoita ja rekisterinpitäjiä on lukuisia. Myös kuntoutuksen määrittely aineistoista osoittautui vaikeaksi. Yhtenäiset tietojärjestelmät kuntoutuksesta palvelisivat paitsi tutkijoita, myös kuntoutujia. Abstract Prevalence and overlap of participation in rehabilitation in different subsystems – a register-based study among residents of the city of Oulu, Finland, in 2018 Knowledge of the whole spectrum of rehabilitation and of the use of different rehabilitation services by the same individuals is quite fragmented and incomplete. The aim of this study is to examine the prevalence and overlap of participation in rehabilitation in different subsystems among residents of the city of Oulu, Finland, in 2018 using extensive register-based data (N=192,844). The study examines rehabilitation organized by the public social and health care system, by the Social Insurance Institution of Finland, by the earnings-related pension system, as well as physiotherapy in occupational health care and private physiotherapy reimbursed by the Social Insurance Institution of Finland. In 2018, 18 per cent of the residents of Oulu received rehabilitation of at least one of the examined subsystems (N=34,061). Receiving rehabilitation of public social and health care was the most common; the rarest was rehabilitation within the earnings-related pension system. Women participated in rehabilitation more often than men. Using rehabilitation services was most common in men aged 65 and over, and in women aged 45–64. It was least common in men aged 16–24 years and in women under 16 years of age. The majority (90%) of those who participated in rehabilitation had participated in rehabilitation of only one subsystem. Participation in rehabilitation of several subsystems was more common in women than in men. It was most common in those aged 45–64 years and least common in those under 16 years of age. Those who received rehabilitation of at least two subsystems were, on average, older than those who received rehabilitation of only one subsystem, and more often women. It is difficult to compile comprehensive register data on rehabilitation, as the system is very fragmented and there are many organizers and registrars. Defining rehabilitation from the data also proved difficult. Unified information systems on rehabilitation would serve not only researchers but also rehabilitees. Keywords: rehabilitation, register-based research, Finland

Validation of the disease experience questionnaire for working age adults with chronic conditions

Background Working age adults diagnosed with chronic diseases are growing in prevalence and not all of them manage to stay at work. Chronic conditions need a long-term response from the (occupational) health care system, which, however, is structured mostly around acute episodes. The aim was to develop and validate a questionnaire tapping working age patients' lived experiences with their chronic disease. Methods Based on a qualitative study, the 13-item Disease Experience Questionnaire (DEQ) was developed for persons in working age. DEQ taps 3 types of disease experiences: 1) Disruption: hopelessness and irreparable loss; 2) Meaningful: an opportunity to set new life priorities; 3) Episode: an inconvenient period to be overcome. Items were filled out online by 2,028 persons diagnosed with chronic headache, autism, HIV, neurofibromatosis, CKD or sarcoidosis. Several proxy variables and demographics were measured. Data were analyzed with PCA, reliability analysis, correlations with criterion variables and ANOVA to compare levels of disease experiences across groups differing in age, education and work status. Results Disruption was valid for all disease groups. Lower educated and non-working persons had significantly higher Disruption levels. Meaningful was valid for the total sample, the autism, HIV and sarcoidosis groups. Cronbach's alphas were .755 and .661 respectively. Episode was only valid for the HIV group (Cronbach's alpha .632). Levels of Meaningful and Episode did not differ in relation to age, education or work status. Correlations with criterion variables were in the expected directions. Conclusions DEQ is a valid tool for identifying disease experiences in working age adults with diverse chronic diseases. The disease experience of persons with HIV, for which also the Episode subscale can be helpful, differs from that of persons with other chronic diseases. The Disruption and Meaningful subscales can help to tailor (occupational) health care to patient needs. Key messages The Disease Experience Questionnaire (DEQ) is a valid tool to identify disease experiences in the working age population with chronic diseases. The DEQ Disruption and Meaningful subscales can help to tailor (occupational) health care to patient needs.