Evaluation research in occupational health services: general principles and a systematic review of empirical studies.

Abstract

Objectives-To study the nature and extent of evaluation research in occupational health services (OHSs) Methods-Literature review of evaluation research in OHSs. On the basis of a conceptual model of OHS evaluation, empirical studies are categorised into aspects of input, process, output, outcome, and OHS core activities. Results-Many methods to evaluate OHSs or OHS activities exist, depending on the objective and object of evaluation. The amount of empirical studies on evaluation of OHSs or OHS activities that met the non-restrictive inclusion criteria, was remarkably limited. Most of the 52 studies were more descriptive than evaluative. The methodological quality of most studies was not high. A diVerentiated picture of the evidence of eVectiveness of OHSs arises. Occupational health consultations and occupational rehabilitation are hardly studied despite much time spent on the consultation by occupational physicians in most countries. The lack of eVectiveness and eYciency of the pre-employment examination should lead to its abandonment as a means of selection of personnel by OHSs. Periodic health monitoring or surveillance, and education on occupational health hazards can be carried out with reasonable process quality. Identification and evaluation of occupational health hazards by a workplace survey can be done with a high output quality, which, however, does not guarantee a favourable outcome. Conclusions-Although rigorous study designs are not always applicable or feasible in daily practice, much more eVort should be directed at the scientific evaluation of OHSs and OHS instruments. To develop evidence-based occupational health care the quality of evaluation studies should be improved. In particular, process and outcome of consultation and rehabilitation activities of occupational physicians need to be studied more. (Occup Environ Med 1999;56:361-377)

Information demands of occupational health physicians and their attitude towards evidence-based medicine

“…OHP may differ from other physicians in that they also perceive a lack of scientific evidence in the field of occupational medicine. This finding is in line with the conclusions of Hulshof et al (12). In contrast to our expectance beforehand, the wide range of contextual aspects in the work of an OHP was not perceived as a barrier to the implementation of the practice of evidence-based medicine.…”

“…Clinical questions in occupational health practice are more concerned with risks, impairments, disabilities, return to work, and lifestyle than with diseases. Another hindrance mentioned is the lack of research evidence in the field, in particular evidence on the efficacy or effectiveness of occupational health activities (12). Finally, an attitude problem is observed, as the majority of OHP would appear to be "reluctant readers" of scientific literature (9).…”

A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial

“…The need for knowledge about the implementation and feasibility of an intervention has been recognized by many authors since the beginning of this decade [6,7]. However, the number of feasibility studies alongside RCTs in the field of occupational health is very limited [1,8,9].…”

Bilan relatif aux dispositions de la LSST

“…Nous avons repéré une revue systématique sur les services de santé au travail (Hulshof et al, 1999), une autre sur les programmes de santé au travail (Bilodeau et Berthelette, 2003), ainsi que deux études concernant les dispositions présentes en Europe (Hämäläienen et al, 2001;Bluff, 2005 Hämäläienen et al (2001 : 8) indiquent que 14 des 17 pays étudiés (les 15 pays de l'Union européenne, plus la Norvège et la Suisse) ont des dispositions légales concernant l'obligation de l'employeur d'organiser des services de santé; ces services étaient disponibles, selon les pays, pour 25 % à 100 % des personnes au travail (p. 7), ce qui est, dans tous les cas, plus élevé qu'au Québec. Westerholm (Westerlholm et Walters, 2007 : 182) suggère que, dans une certaine mesure, l'ambition quant à la couverture des services de santé reflète le fait que la santé au travail soit considérée comme une question de santé publique ou comme un produit sur le marché.…”

“…À l'exception de la réadaptation, ces activités correspondent à des éléments du programme de santé en vertu de la LSST. Hulshof et al (1999) ont recensé cinquante-deux études sur les services de santé au travail (en général, ou sur certaines activités comme les consultations médicales ou sur certains instruments d'intervention). Quatre portent sur des effets intermédiaires ou finaux d'activités susceptibles de se comparer à celles du PSSE, soit celles qui concernent des effets intermédiaires des investigations en milieu de travail, des instruments utilisés ou d'activités de formation/ information.…”