Murphy E, Harrison J, Beach J
Department of Environmental & Occupational Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Occup Med (Lond). 2002 Dec;52(8):497-502. doi: 10.1093/occmed/52.8.497.
Health surveillance is required by UK regulations in certain circumstances, and is usually provided through an occupational health organization. Although there are studies assessing the provision of health surveillance across the country, there are no published studies addressing the practical application of legislation, guidelines and medical research to respiratory health surveillance programmes. An audit of a multidisciplinary health surveillance programme was carried out, using review of occupational health records, occupational hygiene reports and managers' risk assessments, to compare the implementation of health surveillance in different organizations and under different contractual relationships. Sixty-six per cent of National Health Service (NHS) and 56% of industrial workplaces were able to provide risk assessments but were unable to link these with appropriate health surveillance. Twenty-seven per cent of NHS employees potentially exposed to respiratory sensitizers had baseline surveillance, compared with 87% in industry. Fifty-five per cent of Medical Research Council questionnaires were inappropriately administered by the employee themselves, rather than an interviewer as recommended. Other follow-up questionnaires in use had not been formally validated. Non-regular lung function assessment using spirometry was the predominant tool used for follow-up surveillance. There was no overall strategic approach to respiratory health surveillance in the organization studied. Health surveillance programmes should focus on disease prevention without becoming a repetitious application of unvalidated tools. Clinical governance demands quality assurance standards that will effectively implement a coordinated approach to health surveillance.
英国法规在某些情况下要求进行健康监测，通常由职业健康组织提供。尽管有研究评估全国范围内的健康监测情况，但尚无已发表的研究探讨立法、指南和医学研究在呼吸健康监测计划中的实际应用。通过审查职业健康记录、职业卫生报告和管理人员的风险评估，对一个多学科健康监测计划进行了审计，以比较不同组织和不同合同关系下健康监测的实施情况。66%的国民保健制度（NHS）机构和56%的工业工作场所能够提供风险评估，但无法将这些评估与适当的健康监测联系起来。在可能接触呼吸道致敏剂的NHS员工中，27%进行了基线监测，而在工业领域这一比例为87%。55%的医学研究理事会调查问卷由员工自己不恰当地进行管理，而不是按照建议由访谈员进行。正在使用的其他随访调查问卷尚未经过正式验证。使用肺活量测定法进行的非定期肺功能评估是随访监测的主要工具。在所研究的组织中，没有针对呼吸健康监测的总体战略方法。健康监测计划应注重疾病预防，而不是重复应用未经验证的工具。临床治理要求有质量保证标准，以有效实施协调一致的健康监测方法。
