全科医生对职业病的管理：瑞士法语区的一项定性研究。
General practitioners' management of occupational diseases: a qualitative study in French-speaking Switzerland.
作者信息
Coline Gaubicher, Philippe Staeger, Brigitta Danuser, Alessia Abderhalden-Zellweger, Peggy Krief, Zakia Mediouni
机构信息
Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
出版信息
BMC Prim Care. 2025 Jul 2;26(1):207. doi: 10.1186/s12875-025-02888-w.
BACKGROUND
Work-related health problems are a frequent reason for consultation with primary care physicians; however, few studies report on the way general practitioners' (GPs) approach work-related health issues with their patients.
AIM
To investigate the practices of Swiss GPs in regarding work-related health issues presented by their patients, and to identify the resources and difficulties they faced.
METHODS
Semi-structured interviews were conducted with 12 GPs, transcribed, and analyzed thematically.
RESULTS
GPs do explore their patients' occupational field. However, the data collected are limited, even though doctors recognize that a high proportion of mental and musculoskeletal disorders may be work-related. Work-related disease insurance issues are a frequent concern in GPs everyday practice, often causing a discomfort regarding these issues. Exchanges between GPs and employers regarding work-related health issues are relatively uncommon but can yield positive outcomes when they occur. Occupational risk prevention is confined to certain high-risk exposures. When asked to express their difficulties in dealing with work-related issues, GPs mention the lack of dedicated time, insurance issues, contact with employers or the lack of it and lack of training. As for resources, GPs mainly identify specialist doctors, but still, only few of them mention occupational physicians.
CONCLUSIONS
Some work-related pathologies, whether frequent or serious, are not systematically investigated by GPs. This raises the question of their detection and probable under-reporting. To improve anamnesis, identification, and referral practices for occupational health issues, we suggest a targeted training for GPs, strengthened networking among stakeholders-such as occupational physicians, employers and insurers- and a revision of medical billing structures to better support the management of work-related diseases for both GPs and occupational physicians.
背景
与工作相关的健康问题是患者咨询初级保健医生的常见原因；然而，很少有研究报告全科医生（GP）与患者探讨与工作相关健康问题的方式。
目的
调查瑞士全科医生处理患者提出的与工作相关健康问题的做法，并确定他们面临的资源和困难。
方法
对12名全科医生进行了半结构化访谈，进行转录并进行主题分析。
结果
全科医生确实会探究患者的职业领域。然而，尽管医生认识到很大一部分精神和肌肉骨骼疾病可能与工作有关，但收集到的数据仍然有限。与工作相关的疾病保险问题在全科医生的日常实践中经常受到关注，常常引发他们对这些问题的不适。全科医生与雇主之间就与工作相关的健康问题进行的交流相对较少，但一旦发生，可能会产生积极的结果。职业风险预防仅限于某些高风险暴露。当被要求表达他们在处理与工作相关问题时遇到的困难时，全科医生提到缺乏专门时间、保险问题、与雇主的联系或缺乏联系以及缺乏培训。至于资源，全科医生主要确定专科医生，但仍然只有少数人提到职业医生。
结论
一些与工作相关的病症，无论常见与否或严重程度如何，并不能被全科医生系统地调查。这就提出了它们的检测以及可能存在的报告不足的问题。为了改善职业健康问题的问诊、识别和转诊做法，我们建议对全科医生进行有针对性的培训，加强利益相关者（如职业医生、雇主和保险公司）之间的网络联系，并修订医疗计费结构，以更好地支持全科医生和职业医生对与工作相关疾病的管理。
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