Effectiveness of Health Examinations

Kari-Pekka Martimo

Pre-Accession Advisor

INPUT PROCESS OUTPUT OUTCOME

Needs of the work placeCosts to the employerLoss of work timeSkills of OH personnel

Health examination

Number of - examined persons- tests- recommendations- interventions

Improved health, collaboration; succesful employment;

decreased number of OD, WA, risk factors, early retirement,

Process model of health examination

1) Identifying the needs

2) Setting the objectives

3) Intervention

4) Immediate results

5) Long-term results

1. Identifying the needs

• What are the main targets of the health examination (table)?

• How the needs for actions will be identified?

• What is the reliability and acceptability of the chosen methods?

Classification of health examinations

Work-related Not work-related

Primary prevention

Category 1: Recognition of work-related risks (e.g. biological monitoring), assessment of suitability to work

Category 4: Assessment of lifestyle risks

Secondary prevention

Category 2: Early detection of work-related symptoms and signs

Category 5: Early diagnostics of diseases, screening

Tertiary prevention

Category 3: Diminishing the handicap caused by work-related diseases

Category 6: Diminishing the handicap caused by diseases

2. Setting the objectives

• How the objectives will be set?

• How the objectives will be documented?

• How the patient’s/customer’s opinions will be observed?

• How the objectives are understood by the employer and employees?

3. Intervention

• What kind of interventions will be used?

• How work-related issues will be included in addition to individual issues?

• Are the interventions based on evidence?

4. Immediate results

• How the follow-up will be organized and documented?

• Has patient/customer satisfaction been measured?

• Are the results applicable to actions at the work place level?

5. Long-term results

• How the long-term effects of the applied interventions have been proven scientifically?

Summary

• Why?

• What?

• When?

• Who should be informed and how?

• And then?

Ethical considerations

Kari-Pekka Martimo

Pre-Accession Advisor

Basic ethical requirements

1) Avoiding harm

2) Promoting autonomy

3) Promoting justice (equality/equity)

Avoiding harm

• Curative and preventive services

• Are the methods relevant to the risks?

• Reassurance by normal values in unacceptable situations?

• Consequences to the individual and to the work place?

• Benefits of screening?

Autonomy

• Compulsory or voluntary?

• Who makes the decisions based on the results?

• Right to informed consent?

• Right to refuse screening?

• Rights of the service provider?

• Rights of the employer?

Justice

• Discrimination by the results of health examination?

• Primarily actions directed at the individual or the work environment?

• Occupational health services for all?

• Employer’s duty to cover expenses caused by work-related ill-health?

Who wants which?

• Early detection of work-related health effects

• Early initiation of preventive measures

• Early detection of deteriorating work capacity

• Early initiation of rehabilitating and work-related activities

Who wants which?

• Health counselling

• Medical rehabilitation

• Something else?