The role of primary care providers in occupational health

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presentation by dr. Richard Roberts, president of the World Organisation of Family Doctors (Wonca) at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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The role of primary care providers in occupational health

  1. 1. The role of primary careworkers in occupational health Connecting Health and Labour: What Role for Occupational Health in Primary Health Care? WHO-TNO-Government of the Netherlands The Hague, Netherlands 29 November 2011Richard G. Roberts, MD, JDWonca President 2010-2013Professor of Family Medicine, University of WisconsinTEL: +1 608 263 3598 Email: richard.roberts@fammed.wisc.edu
  2. 2. Primary Care & Health Care• The best health systems are based on primary care.• Most health care – including occupational health – can, should and does happen in primary care.• Primary care is especially concerned with knowing the person and context.• People do best when primary care and occupational health care professionals work well together.
  3. 3. The best health systems are based on primary care.
  4. 4. “A world that is greatly out ofbalance in matters of health isneither stable nor secure. . . “ “Primary health care brings balance back to health care, and puts families and communities at the hub of the health system. ““Primary health care also offers the best way ofcoping with the ills of life in the 21st century: theglobalization of unhealthy lifestyles, rapid unplannedurbanization, and the ageing of populations.” Dr Margaret Chan, Director General, WHO - 2008
  5. 5. Primary Care Score vs. Health Care Expenditures, 1997 2 UK DK Primary Care Score NTH 1.5 FIN SP CAN AUS 1 SWE JAP 0.5 GER US BEL FR 0 1000 1500 2000 2500 3000 3500 4000 Per Capita Health Care Expenditures
  6. 6. Relationship between Strength of Primary Care and Combined Outcomes 12 USA GER Primary Care Rank* 10 BEL 8 AUS SWE CAN 6 SP 4 NTH FIN 2 DK UK 0 *1=best 0 1 2 3 4 5 6 7 8 9 11=worst Outcomes Indicators (Rank)
  7. 7. Primary Care Strength and Premature Mortality in 18 OECD Countries 10000PYLL Low PC Countries* 5000 High PC Countries* 0 1970 1980 1990 2000 Year*Predicted PYLL (both genders) estimated by fixed effects, using pooled cross-sectional time series design. Analysis controlledfor GDP, percent elderly, doctors/capita, average income (ppp), alcohol and tobacco use. R 2(within)=0.77.Source: Macinko et al, Health Serv Res 2003; 38:831-65.
  8. 8. Most health care – including occupational health – can,should, and does happen in primary care.
  9. 9. Family Doctors• Doctors of first & last resort – e.g., cancer• Continuous & comprehensive care• Responsible for total health needs• 75% of complaints are self-limited – 80% < 65 years; 40% > 65 years• Time and relationship as diagnostic and therapeutic tools
  10. 10. Healthcare services U.S., 2005Physician office visits 963,617,000Emergency dept visits 115,223,000Hospital outpatient dept visits 90,393,000Hospital discharges 34,667,000Source: National Ambulatory Medical Care Survey, 2005http://www.cdc.gov/nchs/data/ad/ad387.pdf
  11. 11. U.S. Physician Office Visits 20051 512 Million 451 Million600500400 53% 47% 216 Million300 168 Million 129 Million200100 22% 17% 13% 0 Fam Med-GP Internal Medicine Pediatrics All Primary Care Other Specialists 1Excludes anesthesiology, pathology & radiology. Source: http://www.cdc.gov/nchs/data/ad/ad387.pdf
  12. 12. Visit rates by setting type: United States, 1995 and 2005 197 200 % change 180 162 +22%Visits per 100 persons 160 1995 140 2005 120 100 69 80 65 56 +23% 48 +35% 60 37 40 31 40 26 +8% +19% 20 0 Primary Care Surgical Medical Hospital Emergency Office Specialist Specialist Outpatient Department Office Office Department Sources: National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey. http://www.cdc.gov/nchs/data/ad/ad388.pdf
  13. 13. Primary care is especiallyconcerned with knowing the person and context.
  14. 14. Aims & Assets of Primary Health Care• Continuity• Comprehensive
  15. 15. More importantthan knowing the diseaseis knowing the personwith the dis-ease.
  16. 16. It’s theRELATIONSHIP!
  17. 17. People do best when primary care andoccupational health careprofessionals work well together.
  18. 18. What should primary health care professionals …• Know about the workplace? AMAP• Do for work-related problems? AMAP• Do for work-related health risks? AMAPAMAP = As much as possible
  19. 19. What are the barriers?• Culture• Communication• Time• Complexity
  20. 20. Time Requirements• 10.6 hrs/day – chronic conditions1, 2• 7.4 hrs/day – preventive services3• Patient agenda?• Acute care?• Administrative issues? 1. Østbye T. Ann Famed Med 2005; 3:209-214. 2. Tsai et al. Am J Man Care 2005;11:478-88. 3. Yarnall KHS. AJPH 2003;43:635-641. 4. Bodenheimer T. NEJM 2006:355:861-864.
  21. 21. Complexity• Average visit: 1.4 – 8 problems• Diagnoses:  “ologist”: top 5 = 90%  family doctor: top 25 = 60% total Stange KC, et al. J Fam Pract 1998;46(5):363-8.
  22. 22. It’s going to get harder . . .• Change in work: agriculture to manufacturing to service• Change in worker: family duties, older, mental health issues, multiple morbidities

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