C. Kowalski, C. Janssen, H. Pfaff

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1 Improving the cooperation between general and occupational health care: A toolbox for general practitioners and occupational physicians C. Kowalski, C. Janssen, H. Pfaff 29th ICOH International Congress on Occupational Health March 2009 Cape Town, South Africa

2 What is it good for? Improve (preventive) care for the workers / patients Improve cooperation between occupational physicians and general practitioners Seite 2

3 Outline 1) Background 2) ÄrBeK: Improving cooperation between GPs and OPs 3) Prevention pathways 4) ÄrBeK-Toolbox Seite 3

4 Background: The blind spot Situation in Germany: lack of attention to work in general health care, poor overall cooperation between general practitioners and occupational physicians Preventive care provided within the occupational setting is largely unlinked to the preventive and curative care provided by general practitioners and hospitals. This causes a) unnecessary diseases in employees b) costs for the health care system, companies and employees Seite 4

5 Background II Both directions: OPs rarely seek to cooperate with the employee s GP, and the GPs hardly seek contact with OP. Cooperation would be helpful in many situations: Example 1: Family doctor assumes exposures at the workplace Example 2: Occupational practitioner finds risk factors in an occupational health check-up means to facilitate cooperation should be made available Seite 5

6 Background III Attempts to improve OP/GP-cooperation since the 1970s: no results Legal / political situation in Germany is different from that in other countries e.g.: two different Ministries are responsible for health in general (BMG) and for occupational health (BMAS) But: The special situation with lots of small health insurance companies provides a possibility to initiate projects: health insurance companies as driving force Seite 6

7 Objectives of the ÄrBeK-Approach A) to make proposals for precise and stable cooperation between occupational health management and the preventive and curative care provided by patients local physicians: reliable structures + closing the gap between participating groups B) to develop prevention-oriented, indication-specific pathways ( prevention pathways ) Seite 7

8 Overall aim Facilitate cooperation Encourage GPs & OPs to interact They do not have to stick to the pathways Seite 8

9 Method a) literature research in order to identify best practice both in Germany and abroad b) qualitative survey - guided interviews (12 interviews) - group discussions (25 participants) - delphi technique (25 participants) with general practitioners, occupational physicians, health insurance companies Seite 9

10 Pathway requirements (expert opinions) prevention pathways for Musculoskeletal disorders Coronary heart diseases Mental disorders Reasons: Most important disease groups with respect to prevalence, sick leave, costs preventive care can be initiated by company medical officer Seite 10

11 (Unspecific) Prevention Pathway Seite 11

12 ÄrBeK-Toolbox to help implement the pathways into practice as specific as possible contains a detailed description of how to use the ÄrBeK-pathway for both OPs and GPs. it furthermore comprises forms for information exchange including a section of informed consent for disclosure of medical records. copies are provided for GPs, OPs, and patients. Information material is provided to advise the patients of possible preventive or therapeutic steps to be taken. Seite 12

13 Criteria which help create and adhere to functioning structures within integration models 1: Easy access 2: Integration in occupational structures 3: The creation of incentives 4: Raising the awareness of decision-makers 5: Communication and clarity 6: Target group-specific procedures 7: A combination of lifestyle and workplace improvement 8: The qualifications of the actors 9: (Company) health insurance funds and companies that are large enough 10: The brevity of the measures taken 11: The simplicity of the individual services provided 12: The development of a trust culture 13: Formalization 14: Adherence to established guidelines 15: Acceleration of the steps in the treatment process Seite 13

14 Recommendations/Requirements GPs and OPs: Check-ups Occupational health management (large-scale enterprises) Health insurance company Seite 14

15 Seite 15

16 Seite 16

17 Seite 17

18 informed consent for disclosure of medical records patient data reason for consultation risk factors / symptoms job profile / workload medical history, recommended prevention measures Seite 18

19 Conclusions ÄrBeK toolbox: suggestion to facilitate cooperation between GPs and OPs (does not mean GPs/OPs should only interact in the special situation of check-ups) will be made available to the public soon start a discussion ÄrBeK prevention pathways: results will soon be published (German) health insurance company is going to implement an adapted version of pathways Seite 19

20 Thank you for your attention! Contact: Christoph Kowalski Department of Medical Sociology at the Institute for Occupational and Social Medicine - University of Cologne / Germany Seite 20

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