(1) A pilot study in the Netherlands tested having an occupational physician (OP) work as a consultant in 7 primary health care centers to help general practitioners (GPs) with patient referrals, especially for work-related health issues. (2) Over 7 months, the OPC consulted on 184 patient referrals from GPs, with the most common diagnoses being psychological (52%) and musculoskeletal (26%). (3) Based on the results, GPs found the OPC useful in identifying work-related health problems early to provide appropriate care and advice on returning to work.

1. The occupational physician as a consultant in
primary care:
Noks Nauta and pilot studyCentre of Netherlands
results of a André Weel, in the Excellence,
Netherlands Society of Occupational Medicine, Utrecht, the
Netherlands Over the 7 primary health care centres, 7 OPCs, 28
In the Netherlands, primary and occupational health
care are separated. This impedes effectiveness of care GPs and 17 other professionals (psychologists,
and return to work. In 2006, the Netherlands Society of physiotherapists) participated. Medical date were
Occupational Medicine carried out a pilot study. In 7 recorded on a registration form. Patients and
primary health care centres an occupational physician professionals were interviewed about their
(OP) was working as a consultant (OPC) for some opinions.
months. General practitioners (GPs) could refer patients
to the OPC directly.
Patients referred to the OPC, per The OPC surrounded by the GPs of
diagnosis frequency
diagnosis percent the primary health care center in
Psychological 96 52 Eindhoven
Musculoskeletal 47 26
Neurological 5 3
Cardiovascular 4 2
Other 32 17
Total 184 100
Patients absent from work
Absent 107 (58%)
Work-relatedness according to
OPC of OPC
Opinion Numbers of
Working 77 (42%)
patients
Total 184 (100%) Not work-related 30 (17%)
Probably not work-related 11 (6%)
Possibly work-related 26 (15%)
Work-relatedness according to GP
Opinion of referring GP Numbers of patients Probably work-related 40 (23%)
Probably work-related 127 (81%) Certainly work-related 65 (38%)
Probably not work-related 21 (13%) Total 173 (100%)
Unclear 9 (6%)
Total 157 (100%)
Conclusions
(1) The OP in a primary health care setting traces work-related health problems in a
very early stage (before sick leave) and advises about solutions.
(2) The GP is convinced about the important (positive or negative) influence of work
factors on health and well-being.
(3) The GP is more prone to refer patients with work-related health complaints to the
OP.
A follow up project in primary care has recently started, with the focus on workers’
empowerment.
Our recommendation: give the OP a front position in primary
health care!
ICOH2009 Cape Town March 2009 ----- E-mail of authors: n.nauta@nvab-online.nl &
a.weel@nvab-online.nl