Conference day 21 What is the role and the functions of primary-care centre regarding thehealth of workers and under which conditions this role can be expanded?Work healthy – should have relationship with PCRelationship doctor – patient communication, GP knows the patient.Self employed, informal sector, all people should have access to OHCompany doctors, treating families. GP responsible for all aspects of healthcare, including OH.PHC can do a lot, from prevention to disability assessment.Who are the patients and what do they needOH is specialty, special knowledge.Not shifting OH to GP. GP can help. OH history. OH specialist assume GP doesnot know about work. GP may know more than expected. When completeannual exam: full OH history, then relevant. Use tools, integrate in electronicrecord. Open MRS system – also access in developing countries.Need for electronic system with all data, GP, OP and hospitalRegister work with demographic data.Training paramedics.Summary: GP listen and know worker, collaboration, incentives, infrastructure,funding, access to OH for everybody. Tool for GP to assist with info, what canGP do for worker – integrate. Utilize guidelines, VE OH can be integrated, all HSin one centre, including assessments. Limitation when injuries, hospital care.OH Care is multidisciplinair.Policy to educate GPs in OH.
2 How to strengthen the collaboration between occupational health andprimary care providers, services, centres and what capacities, skills, andsupport is needed for this?Task GP: recognize OH problems and refer to OH specialist or actually treat OHdiseases?Establish effective referral system between PC en OHEducation, knowledgeLegislationHuman resourcesProjects that show benefit of collaborationTraining together (GP/OP)Administrative issue: report to same source (GP/OP)Make OH an important part of training GP (>150 hrs), possibilities: classes,online, practice, CME.Easy access for GP to OH-information by computer, integration occupationaldisease in health information system, use same classificationCollaboration: multi-morbidity, mental disordersRelationship with patient differs for GH /OH problems.Identify stakeholders, let them see benefits of collaboration.Summary: identify and involve stakeholders, enhance collaboration throughtraining, GPs and OPs should know each other and patients should know theirdoctors, Doctors should work for the same population, lack of focus onreintegration, administrative and financial barriers should be removed, need ofresearch on collaboration, joined committees for OC and PC.
3 What support is needed to empower workers, work communities,enterprises to take care of their health and what is the role of primary carecentres and occupational health services in providing such support?Use media, modern techniques, to raise awareness, health promotioncampaign in the workplace. Keep in mind: sometimes no time for media (longworking days). Face-to-face communication also important, for example duringlunchtime in factory.Workers can keep own recordIdentify what kind of workers in community - involve workers/ community,involve NGO’s, unionsWorker needs to know: what does it mean to me, etc. pres Richard. Patientneeds knowledge about what he should and can do, and capabilities to act onit. Help with legal issues, how to deal with legal issues.Barrier: not allowed to visit doctor during working time. Regulation for easyaccess for workers to visit GP/OPEducation, orientation program, refresh coursesPromote participationWorker satisfaction, involve workers. Ask workers what they needAttention for womenCPD for workers, for example with bonus after reaching certain levelGPs and OPs should give a good exampleWHO: program healthy work places, take care of their own health problems,empower communities.OH center for all workers with independent doctors/ public.Where do you go with complaints? Who can protect the child who works withpoisonous substances
Summary: motivate workers to change behavior, use different techniques,involve workers, involve stakeholders like unions, Ngo’s etc, consider individualcontext. Legal issues. Ensure access to occupational health care.4 What actions should be undertaken to move to people-centred careregarding workers health at the local, national and international level,including research to fill knowledge gaps?Legislation: good OH care for workersCommunity based participatory research and action research, development oftoolsMedical schools: OH research involvementInvolve insurance companiesInternational independent survey on needs for empowerment, includinginformal workersReach out to nurses, community health workers, allied health professionalsEducation students, education prgramMake it easy to do the right thing (food, exercise etc)Needs assessment for local situation, culture sensitiveStart knowledge at school, medical studentsInfrastructureEvaluationPartnership with people, gender specificChange in management, educate bossesGuidelines, instructions, protect qualityGlobal initiative increasing number of training centers, also in countries wherethey do not have them now. Training should be accessible all over the world.Training setting also needs services, residents need to see proper setup for
OHS. Sometimes training abroad necessary. Worldwide legislation. We shouldtrain OH nurses.Need of occupational health care needs to be accepted.Appropriate obligatory postgraduate training in OHS of GPsHazard identification, risk assessmentOccupational health/ medical services Directive (EU)Independent financingLiberalization of services not possible without quality controlAttention for women workersCoordinate across ministries, countries, continentsTechnical support for physiciansSum: research, legislation, training also providers, infrastructure, support