Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations

Abstract

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

Feasibility of clinicians asking patients about their exposure to occupational hazards: An intervention at five primary care health centres

“…Interestingly, similar barriers have recently been identified by researchers at the Migrant Clinicians Network, based in Austin Texas [31]. They listed major barriers encountered by clinicians and community health workers at community health centres to providing occupational healthcare, including competing priorities, limited appointment time, and lack of training.…”

Courses on Basic Occupational Safety and Health: A Train-the-Trainer Educational Program for Rural Areas of Latin America

“…The teams realized that the relationship between work and community health problems was unknown to the communities' health care staff. This so-called "blind spot" in occupational health [51,52] of health care providers is well known globally [24,25,41,49,[51][52][53][54]. Likewise, local authorities were unaware of the association between work and health.…”

“…Teams even suggested to deepen the training; however, longer workshops would have been difficult to carry out due to time constraints especially for the rural health care professionals. One has to bear in mind, that frequently only one health care professional works together with an internal in a rural community and thus, leaving the community for longer periods of time is hard to compensate [25]. Therefore, we offered parts of the program online.…”

“…For example, for one case of pesticide poisoning notified, 50 are not reported [23]. The absence of infrastructure, adequate public policies, accessibility, and trained primary healthcare professionals in occupational health is a prevailing barrier not only in Brazil [1,19,20,24,25].…”

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

“…Health care facilities and providers may provide unreimbursed care to uninsured workers. Community health centers (CHCs) may be particularly burdened by underutilization of WC (Azaroff et al, 2013; Lashuay & Harrison, 2006; Simmons, Liebman, & Sokas, 2018; Topete, Forst, Zanoni, & Friedman, 2018). CHC managers and clinicians have reported absorbing work-related health care costs; for example, “we see an awful lot of work-related injury, and I would say that most of it doesn’t go through workers’ comp” (Azaroff et al, 2013, p. 1375).…”