Patient–physician communication about work-related asthma: what we do and do not know

Mazurek, Jacek M.; White, George L.; Moorman, Jeanne E.; Storey, Eileen

doi:10.1016/j.anai.2014.10.022

Cited by 18 publications

(11 citation statements)

References 43 publications

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“…Two other factors that seem to contribute to the delays in diagnosis and poor education of WRA are communication between doctors and patients and the time constraints of physicians. A significant number of people fail to mention the potential relationship between their work and asthma symptoms to doctors, and only one in seven asthma patients communicate their workplace might induce their asthma to doctors [ 41 , 42 ]. This could be due to multiple factors, such as the patients not being aware themselves of the workplace irritants, fear of diagnosis for causing job loss or impact their income, and fear of stigma from the employer [ 4 , 13 , 24 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

MacKinnon

Ramsey

et al. 2020

Allergy Asthma Clin Immunol

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Background: Work-related asthma (WRA) accounts for up to 25% of all adults with asthma. Early diagnosis is key for optimal management as delays in diagnosis are associated with worse outcomes. However, WRA is significantly underreported and the median time to diagnosis is 4 years. The objective of this review is to identify the gaps in awareness and reporting of WRA and identify gaps in current knowledge translation strategies for chronic disease in general, and asthma specifically. This will identify reasons for delays in WRA diagnosis, as well inform suggestions to improve knowledge translation strategies for dissemination and implementation of WRA prevention and management guidelines. Methods: Non-systematic literature reviews were conducted on PubMed with a focus on work-related asthma screening and diagnosis, and knowledge translation or translational medicine research in asthma and chronic disease. In total, 3571 titles and abstracts were reviewed with no restriction on date published. Of those, 207 were relevant and fully read. Another 37 articles were included and reviewed after citation reviews of articles from the initial search and from suggestions from editors. In total, 63 articles were included in the final review. Results: Patients, employers, and healthcare professionals lack awareness and under-report WRA which contribute to the delayed diagnosis of WRA, primarily through lack of education, stigma associated with WRA, and lack of awareness and screening in primary care. Knowledge translation strategies for asthma research typically involve the creation of guidelines for diagnosis of the disease, asthma care plans and tools for education and management. While there are some prevention programs in place for certain industries, gaps in knowledge translation strategies including lack of screening tools currently available for WRA, poor education of employers and physicians in identifying WRA, and education of patients is often done post-diagnosis and focuses on management rather than prevention or screening. Conclusion: Future knowledge translation strategies should focus on educating employees and employers well before potential exposure to agents associated with WRA and screening for WRA in primary care to enable health care providers to recognize and diagnose WRA.

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Section: Resultsmentioning

confidence: 99%

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

MacKinnon

Ramsey

et al. 2020

Allergy Asthma Clin Immunol

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“…Although patients with medical issues, such as symptoms of asthma that may be caused by the work environment, are usually first seen by primary care providers (PCPs), these patients are not regularly asked about their work situations. [1][2][3][4][5] While occupational health specialists have developed evidence-based guidelines to manage such patients, PCPs are rarely aware of the existence of these guidelines. 6 Computerized clinical decision support (CDS) tools could be used to increase awareness and provide guidance, but they must be developed and implemented with care in conjunction with the users who would benefit from the CDS.…”

Section: Background and Significancementioning

confidence: 99%

Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

et al. 2020

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Background Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. Objective This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. Methods We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. Results We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. Conclusion We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

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“…It is possible that case reports and cases identified via surveillance are unable to fully reveal the occupational contribution to asthma mortality as the association of an asthma death with occupational exposures can go unnoticed [42][43][44][45][46]. For example, previous studies reported that some physicians take inadequate occupational histories from their asthma patients and do not refer suspected cases to occupational medicine or pulmonary physicians for additional evaluation [42,43].…”

Section: Work-related Asthma Death Case Reportsmentioning

confidence: 99%

Use of population data for assessing trends in work-related asthma mortality

Mazurek

Henneberger²

2019

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review-Work-related asthma has been associated with poorer asthma control and frequent unscheduled healthcare visits, and can be fatal. Case reports of work-related asthma deaths are rare, but can initiate efforts to prevent additional cases. We reviewed relevant literature and data sources to evaluate whether analyzing mortality data at the population level can help identify potential sources of exposures that contribute to work-related asthma. Recent findings-A limited number of population-based studies have addressed work-related asthma mortality. Data on asthma mortality are derived from death certificates using the International Classification of Diseases (ICD) as a standard for coding cause. However, no discrete code for work-related asthma is available. Analysis of asthma mortality relative to industries and occupations appears to identify high-risk jobs that were not identified by analyzing asthma morbidity data. Summary-Beyond recognized work-related asthma deaths, it is possible that occupational exposures have contributed to other asthma deaths that have gone unnoticed and could potentially be identified by the analysis of mortality data at the population level. Such analyses in the United States appear to assist in recognizing high-risk occupations and industries. Additional analyses would be possible if a work-related asthma ICD code were available.

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Patient–physician communication about work-related asthma: what we do and do not know

Cited by 18 publications

References 43 publications

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

Improving detection of work-related asthma: a review of gaps in awareness, reporting and knowledge translation

Clinical Decision Support for Worker Health: A Five-Site Qualitative Needs Assessment in Primary Care Settings

Use of population data for assessing trends in work-related asthma mortality

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