TNO Work and Health, PO Box 718,, 2130, AS, Hoofddorp, The Netherlands.
BMC Health Serv Res. 2012 Aug 31;12:294. doi: 10.1186/1472-6963-12-294.
The working population is ageing, which will increase the number of workers with chronic health complaints, and, as a consequence, the number of workers seeking health care. It is very important to understand factors that influence medical care-seeking in order to control the costs. I will investigate which work characteristics independently attribute to later care-seeking in order to find possibilities to prevent unnecessary or inefficient care-seeking.
Data were collected in a longitudinal two-wave study (n = 2305 workers). The outcome measures were visits (yes/no and frequency) to a general practitioner (GP), a physical therapist, a medical specialist and/or a mental health professional. Multivariate regression analyses were carried out separately for men and women for workers with health complaints.
In the Dutch working population, personal, health, and work characteristics, but not sickness absence, were associated with later care-seeking. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. Women experience more health complaints and seek health care more often than men. For women, experiencing a work handicap (health complaints that impede work performance) was the only work characteristic associated with more care-seeking (GP). For men, work characteristics that led to less care-seeking were social support by colleagues (GP frequency), high levels of decision latitude (GP frequency) and high levels of social support by the supervisor (medical specialist). Other work characteristics led to more care-seeking: high levels of engagement (GP), full time work (GP frequency) and experiencing a work handicap (physical therapist).
We can conclude that personal and health characteristics are most important when explaining medical care-seeking in the Dutch working population. Work characteristics independently attributed to medical care-seeking but only for men and only for the frequency of visits to the GP. The association between work characteristics and later medical care-seeking differed between health care providers and between men and women. If we aim at reducing health care costs for workers by preventing unnecessary or inefficient care, it is important to reduce the number of workers that report that health complaints impede their work performance. The supervisor could provide more social support, closely monitor workload in combination with work pressure and decision latitude, and when possible help to adjust working conditions. Health care providers could reduce medical costs by taking the work relatedness of health complaints into account and act accordingly, by decreasing the time to referral and waiting lists, and by providing appropriate care and avoiding unnecessary or harmful care.
劳动人口老龄化，这将增加患有慢性健康问题的劳动者人数，因此寻求医疗保健的劳动者人数也将增加。了解影响医疗保健寻求的因素对于控制成本非常重要。我将调查哪些工作特征独立导致以后的就医，以寻找防止不必要或低效就医的可能性。
数据来自一项纵向两波研究（n=2305 名工人）。结果测量指标是就诊（是/否和频率）给全科医生、物理治疗师、医学专家和/或心理健康专家。对有健康问题的男性和女性工人分别进行多变量回归分析。
在荷兰的劳动人口中，个人、健康和工作特征，但不是病假，与以后的就医有关。工作特征独立地导致了医疗保健的寻求，但仅对男性，并且仅对看全科医生的频率有影响。女性比男性经历更多的健康问题，并且更频繁地寻求医疗保健。对于女性，工作障碍（妨碍工作表现的健康问题）是与更多就医相关的唯一工作特征（看全科医生的频率）。对于男性，导致较少就医的工作特征是同事的社会支持（看全科医生的频率）、高水平的决策自由度（看全科医生的频率）和主管的高水平社会支持（医学专家）。其他工作特征导致更多的就医：高投入水平（看全科医生）、全职工作（看全科医生的频率）和工作障碍（物理治疗师）。
我们可以得出结论，在解释荷兰劳动人口的医疗保健寻求时，个人和健康特征是最重要的。工作特征独立地导致了医疗保健的寻求，但仅对男性，并且仅对看全科医生的频率有影响。工作特征与以后的医疗保健寻求之间的关联因医疗保健提供者和男性和女性而异。如果我们的目标是通过预防不必要或低效的医疗保健来降低工人的医疗保健成本，那么重要的是要减少报告健康问题妨碍工作表现的工人人数。主管可以提供更多的社会支持，密切监测工作量与工作压力和决策自由度的结合，并在可能的情况下帮助调整工作条件。医疗保健提供者可以通过考虑健康问题与工作的相关性并采取相应措施来降低医疗成本，例如减少转介和候诊时间，提供适当的护理，并避免不必要或有害的护理。
