Rodríguez-Jareño Mari Cruz, Molinero Emilia, de Montserrat Jaume, Vallès Antoni, Aymerich Marta
University of Girona, Catalonia, Spain (School of Medicine, Department of Medical Sciences).
Ministry of Enterprise and Labour, Government of Catalonia, Spain (Occupational Health and Safety Institute).
Int J Occup Med Environ Health. 2017 Oct 6;30(6):823-848. doi: 10.13075/ijomeh.1896.00911. Epub 2017 Sep 11.
Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim.
A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine. The questionnaire included factual questions on how they performed health examinations in their usual practice. The bivariate analysis of the answers was performed by type of occupational health service (external/internal).
The response rate was 57.9% (N = 168), representing 40.3% of the reference population. A high percentage of occupational physicians had important limitations in their current medical practice, including availability of clinical and exposure information, job-specificity of tests, and early detection and appropriate management of suspected occupational diseases. The situation in external occupational health services - that covered the great majority of Catalan employees - was worse remarkably in regard to knowledge of occupational and nonoccupational sickness absence data, participation in the investigation of occupational injuries and diseases, and accessibility for workers to the occupational health service.
This study raises serious concerns about the occupational preventive usefulness of these health examinations, and subsequently about our health surveillance system, based primarily on them. Professionals alongside health and safety institutions and stakeholders should promote the rationalization of this system, following the technical criteria of need, relevance, scientific validity and effectiveness, whilst ensuring that its ultimate goal of improving the health and safety of workers in relation to work is fulfilled. Other countries with similar surveillance systems might be encouraged by our results to assess how their practices fit the intended purpose. Int J Occup Med Environ Health 2017;30(6):823-848.
尽管常规的职工健康检查在全球范围内广泛开展且涉及重要的资源分配，但很少有研究分析其质量。本研究的目的是从职业预防目的的角度分析加泰罗尼亚（西班牙）职工健康检查的医疗实践。
通过在线调查对加泰罗尼亚安全与职业医学协会成员中的职业医生进行了一项横断面研究。问卷包含关于他们在日常实践中如何进行健康检查的实际问题。答案的双变量分析按职业健康服务类型（外部/内部）进行。
回复率为57.9%（N = 168），占参考人群的40.3%。很大比例的职业医生在其当前医疗实践中存在重大限制，包括临床和接触信息的可用性、检查的针对性、疑似职业病的早期发现和适当管理。外部职业健康服务覆盖了加泰罗尼亚的绝大多数员工，在职业和非职业病假数据的了解、参与职业伤害和疾病调查以及工人获取职业健康服务的便利性方面情况明显更差。
本研究引发了对这些健康检查的职业预防效用的严重担忧，进而对主要基于这些检查的健康监测系统产生担忧。专业人员以及健康与安全机构及利益相关者应按照需求、相关性、科学有效性和有效性的技术标准，推动该系统的合理化，同时确保实现改善工人与工作相关的健康和安全这一最终目标。我们的研究结果可能会促使其他具有类似监测系统的国家评估其做法是否符合预期目的。《国际职业医学与环境卫生杂志》2017年；30(6):823 - 848。
