Completing the picture: Collecting workplace exposure information from community health clinics' patients

Status: in progress

Purpose:

This study will determine whether it is feasible within a clinical setting to ask workers about their current occupational exposures, risks, and incidents in order to provide a means to identify people potentially exposed to hazardous substances or dangerous situations in the workplace.

Background:

We currently do not have a systematic way to determine what occupational disease risks and injury hazards workers are exposed to at a regional level. This information is needed to help identify and monitor the health needs and health status of the population and help inform long-term prevention efforts.

We can gain insight into workers’ potential exposures from sources such as environmental information reported by companies to the National Pollutant Release Inventory of Environment Canada, samples of individual workplaces by inspectors or consultants, and from gross data that we collect from imports, exports and manufacturing data. However, it is difficult to incorporate these data into a monitoring system at the population level. Incorporating self-identified workplace exposure information into patients’ medical charts at community health centres would allow doctors or researchers to identify potentially at-risk workers and to broadly monitor exposure prevalence within the local population.

Methods:

We are developing a brief survey that asks questions on present-day work exposures, risks, and incidents such as chemicals, airborne particulates, vibration, heavy lifting, and slips, trips and falls. The survey will be distributed at several Community Health Centres (CHCs) in Ontario. CHCs offer a location within specified geographical catchment areas that can be used to collect information on workers in these areas. CHCs are generally representative of the local working population, especially in more rural areas where they are often the main source of primary medical care. The answers to the exposure and risk questions will be scanned or entered into the patients’ electronic medical records.

The results of the feasibility study will be used to determine whether community health centres can be used as a basis for undertaking exposure surveillance in working populations; whether adding these exposure questions to an existing clinical process is feasible; and whether this basic method can collect meaningful information on workplace exposures and risks. We will also use interviews to explore clinicians’ concerns around any challenges they may face in asking the questions (such as the time required) and whether patients are able to understand and answer the questions (for example, questions on duration and intensity of exposure). Finally, we will determine whether this initiative increases clinicians’ knowledge about occupational exposures, and will test tools for making use of this information at the individual and population levels.

Implications:

This information is expected to produce two clear benefits.  For primary prevention purposes, the information can be evaluated to identify exposure and risk patterns by geographic area and sector in the local population. The information can also be used to identify potential exposures that require further investigation, and to determine if they may contribute to disease development in individual workers. Clinicians can play an important role in identifying potential exposures that require additional followup. Exposure surveillance is essential in the field of occupational health to continuously assess the risks and health hazards associated with workplaces; the ultimate goal of such activity being to inform prioritization and decision-making around prevention efforts.

Progress:

This study commenced in September 2014. The pilot at Bramalea Community Health Centre has been initiated and networking with other CHCs has commenced.

Resources:

Completing the Picture one pager
Overview of the project – November 2014

Funding:

Funding for this study was received from the Canadian Cancer Society Research Institute and Canadian Institutes of Health Research:

Kramer, D.M., Holness, D.L., Lightfoot, N.E., Kudla, I., Arrandale, V., Wells, R.P. Completing the Picture: Collecting workplace exposure information from community health clinics’ patients. Canadian Cancer Society Research Institute (CCSRI) and Canadian Institutes of Health Research (CIHR): Prevention Research Grant. $369,680.

Investigators:

Desre M. Kramer (Occupational Cancer Research Centre)
D. Linn Holness (Centre for Research Expertise in Occupational Disease and St. Michael’s Hospital)
Richard Wells (Centre of Research Expertise for the Prevention of Musculoskeletal Disorders)
Nancy Lightfoot (Laurentian University)
Irena Kudla (St. Michael’s Hospital)
Hal De Lair (Bramalea Community Health Centre)
Victoria Arrandale (Occupational Cancer Research Centre)
Rivka Kushner (Occupational Cancer Research Centre)
Christine Carthew (Occupational Cancer Research Centre)