Occupational Health Clinicians Research Articles

Best Practices in Documenting and Coding High-Value Care in Workers' Compensation Encounters - ACOEM Guidance Statement.

Workers' compensation outpatient care requires attention to causation, functional assessment, work disability prevention and return-to-work planning, elements not usually addressed in other types of outpatient encounters. Because these elements of care deviate from the usual pattern of ambulatory services, providers of workers' compensation care have faced challenges in billing and auditing practices resulting in underpayment when providing high-value care based on evidence-based guidelines. Recent changes in Centers for Medicare and Medicaid Services rules on documentation requirements for coding outpatient evaluation and management encounters offer an opportunity for occupational health clinicians to be paid appropriately for care that follows occupational medicine practice guidelines. There remains a need to define the elements of documentation that should be expected in delivering high-value workers' compensation care. This paper provides guidance for documenting high-value workers' compensation care.

Assessing the profile and utility of diplomates in occupational medicine.

The utility of the occupational medicine diploma in the UK is yet to be explored. The NHS 'Growing Occupational Health (OH) and Wellbeing' programme provides opportunities for diplomates to increase their OH work. To assess what proportion of diplomates carry out OH work, the type of work being undertaken, to identify obstacles impeding OH work, to capture their interest in future work opportunities and what additional support they require. A link to an online questionnaire was sent to diplomates via several professional bodies; we estimate that 2428 diplomates received this. The survey was open from 24 March to 31 May 2022. Replies were received from 310/2428 (13%) diplomates. Fifty-two per cent of respondents were males and 35% were female. Respondents were diverse in terms of age and geographical region. Main employment settings: 13% primary care, 43% secondary care, 31% private sector, 24% public sector and 20% self-employed. Seventy-two per cent of diplomates had undertaken OH clinical work since completion of their diploma, and 90% of those were undertaking OH clinical work at the time of the survey. Specific obstacles to accessing OH work highlighted included existing workload constraints, lack of employment opportunities with OH providers and lack of time. Many (126/310; 41%) respondents had considered increasing their OH work in the previous 12 months. Increasing mentorship from senior OH clinicians to diplomates was suggested by 4% of respondents to enhance the utility of diplomates.

False-positive HIV screening test in a healthcare student.

This case report describes a 22-year-old female Ambulance Technician student who displayed human immunodeficiency virus (HIV) false positivity following a recent hepatitis B vaccination. Occupational health clinicians who work in a healthcare setting (with healthcare staff and/or students) should be aware of the possibility of false-positive HIV screening test results, and where a false positive is suspected, they should consider what the underlying cause could be and should consider whether further medical investigation is required.

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

BackgroundEmployee Occupational Health (‘occupational health’) clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could...

Assessing the psychosocial impact of stammering on work.

Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life. To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention. A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention. Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work. Stammering can have a negative impact of workers' job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention.

Potential sources and characteristic occurrence of mobile colistin resistance (mcr) gene-harbouring bacteria recovered from the poultry sector: a literature synthesis specific to high-income countries.

Understanding the sources, prevalence, phenotypic and genotypic characteristics of mcr gene-harbouring bacteria (MGHB) in the poultry sector is crucial to supplement existing information. Through this, the plasmid-mediated colistin resistance (PMCR) could be tackled to improve food safety and reduce public health risks. Therefore, we conducted a literature synthesis of potential sources and characteristic occurrence of MGHB recovered from the poultry sector specific to the high-income countries (HICs). Colistin (COL) is a last-resort antibiotic used for treating deadly infections. For more than 60 years, COL has been used in the poultry sector globally, including the HICs. The emergence and rapid spread of mobile COL resistance (mcr) genes threaten the clinical use of COL. Currently, ten mcr genes (mcr-1 to mcr-10) have been described. By horizontal and vertical transfer, the mcr-1, mcr-2, mcr-3, mcr-4, mcr-5, and mcr-9 genes have disseminated in the poultry sector in HICs, thus posing a grave danger to animal and human health, as harboured by Escherichia coli, Klebsiella pneumoniae, Salmonella species, and Aeromonas isolates. Conjugative and non-conjugative plasmids are the major backbones for mcr in poultry isolates from HICs. The mcr-1, mcr-3 and mcr-9 have been integrated into the chromosome, making them persist among the clones. Transposons, insertion sequences (IS), especially ISApl1 located downstream and upstream of mcr, and integrons also drive the COL resistance in isolates recovered from the poultry sector in HICs. Genes coding multi-and extensive-drug resistance and virulence factors are often co-carried with mcr on chromosome and plasmids in poultry isolates. Transmission of mcr to/among poultry strains in HICs is clonally unrestricted. Additionally, the contact with poultry birds, manure, meat/egg, farmer’s wears/farm equipment, consumption of contaminated poultry meat/egg and associated products, and trade of poultry-related products continue to serve as transmission routes of MGHB in HICs. Indeed, the policymakers, especially those involved in antimicrobial resistance and agricultural and poultry sector stakeholders-clinical microbiologists, farmers, veterinarians, occupational health clinicians and related specialists, consumers, and the general public will find this current literature synthesis very useful.

Occupational health in mental health services: a qualitative study

Purpose The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service. Design/methodology/approach Thematic analysis of data from seven semi-structured interviews is performed in this paper. Findings Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment. Research limitations/implications This was a small scale study of a previously unresearched population. Practical implications These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace. Originality/value This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.

Checklist for psychosocial risk evaluation: a prospective evaluation study.

Although psychosocial risk evaluation (PRE) is legally required, implementation is often suboptimal. Occupational health specialists face various challenges in implementing a systematic PRE process. To evaluate if a checklist strengthens the competencies of occupational physicians in PRE design and implementation. A prospective pilot survey with a baseline and follow-up assessment at 12 months was conducted with occupational physicians who applied the checklist. Three outcome criteria were assessed: (i) physicians' general competence in PRE, (ii) physicians' self-reported skills in PRE and (iii) feasibility of the checklist. Twenty-four occupational physicians participated. Checklist users reported increased competence in PRE at follow-up, increasing in competence twice as much as physicians who did not use the checklist during the study period although this was not statistically significant. With regard to specific skills over time, checklist users reported increased knowledge of the PRE procedure (P < 0.05), as well as increased strategic planning for PRE (P < 0.01). All feasibility criteria were rated positively. Our checklist may help occupational health clinicians to overcome the barriers that are responsible for the gap between official recommendations and occupational health and safety practice in PRE. However, our results are based on a preliminary study with a limited sample size.

Progressing From Metformin to Sulfonylureas or Meglitinides

The article provides an overview of sulfonylureas and meglitinides as second-line agents for treating type 2 diabetes mellitus (T2DM). Implications for occupational health clinicians who work with these individuals when they take either of these medications to achieve target glycemic indices are emphasized.

Development and Implementation of Clinical Algorithms in Occupational Health Practice

Occupational health (OH) practice is framed by legal, ethical, and regulatory requirements. Integrating this information into daily practice can be a difficult task. We devised evidence-based framework standards of good practice that would aid clinical management, and assessed their impact. The clinical algorithm was the method deemed most appropriate to our needs. Using "the first OH consultation" as an example, the development, implementation, and evaluation of an algorithm is described. The first OH consultation algorithm was developed. Evaluation demonstrated an overall improvement in recording of information, specifically consent, recreational drug history, function, and review arrangements. Clinical algorithms can be a method for assimilating and succinctly presenting the various facets of OH practice, for use by all OH clinicians as a practical guide and as a way of improving quality in clinical record-keeping.

New Principles of Best Practice in Clinical Audit

This book is a revision and reinterpretation of the classic text on clinical audit, Principles of Best Practice in Clinical Audit, which was first published in 2002. It is a truly practical guide to audit methodology. The book’s editor, Robin Burgess, is chief executive of the Healthcare Quality Improvement Partnership (HQIP), the organization responsible for supporting clinical audit in Great Britain. Robin is an enthusiastic advocate and this comes through in the accessible chapters that he has authored. The book is aimed at anyone who uses clinical audit or who is interested in it as a quality improvement methodology. While its main focus is clinical audit within the National Health Service, the text is equally applicable to occupational health practice both within and outside a health care setting. Do not be daunted by the length of the book. There are only 86 pages covering the four stages of clinical audit: preparation, measuring performance, implementing change and sustaining improvement. These chapters are very clear with short paragraphs and bullet pointed lists. The remaining pages are divided into eight appendices. The first of these provides particularly helpful guidance on the ethics of clinical audit and answers that age old question, what is the difference between research and audit and when do I need ethical approval? The introduction addresses important questions such as: what is clinical audit designed to do?, does clinical audit change practice? (it can) and should we audit process or outcome? And for me, two of the most important take home messages are: ‘clinical audit is a change process’ and ‘poorly conceived clinical audits . . . are a waste of everyone’s time and are not likely to result in any improvement in care’. This book touches on the philosophy, science and ethics of clinical audit as well as providing practical instructions for executing a clinical audit project. I think all occupational health clinicians, at whatever stage in their career, will find it a very useful text.

The relationship between job satisfaction and health: a meta-analysis

Background: A vast number of published studies have suggested a link between job satisfaction levels and health. The sizes of the relationships reported vary widely. Narrative overviews of this relationship...

Bloodborne Pathogens

Bloodborne pathogen exposures remain a significant occupational hazard to all health care professionals. Primary preventive strategies, such as standard precautions and the availability of the hepatitis B vaccine to all health care workers, have been instrumental in decreasing the potential for life threatening exposures to HBV, HCV, and HIV. Updated work practices and engineering controls, including the use of safer medical devices, will continue to further reduce the potential risk of exposures to workers. Occupational health clinicians are in a pivotal position to foster primary preventive strategies. Ongoing education to health care professionals about the general prevalence, risk of transmission, and availability of prophylaxis and treatment is imperative. Knowledge related to the importance of taking basic precautions through the use of gloves, gowns, and masks has been proven to decrease exposure incidents. Many health professionals are experts in their specialty areas, but are unfamiliar with the latest data related to the prevention and treatment of exposures to bloodborne pathogens. Some perceive they are at little risk, and others have untoward fears. Secondary preventive intervention strategies are evolving each year through the use of new prophylactic medications for HIV and the possibility of prophylaxis for HCV. Occupational health clinicians must be updated about the latest strategies for the management of bloodborne pathogen exposures (see Appendix for a list of resources).