Use of a Questionnaire to Improve Occupational and Environmental History Taking in Primary Care Physicians

Abstract

New patient charts were reviewed before and after the introduction of a self-administered questionnaire, designed to elicit occupational and environmental (OE) information from patients. The Occupational Health Risk Assessment questionnaire (OHRA) was expected to prompt primary care physicians to make further inquiries into OE health issues. Chart reviews determined the amount and type of information detailed in the primary care physicians' notes. Twenty-three percent of completed OHRAs indicated a job-related health problem. Despite a high prevalence of self-reported work-related symptoms and exposures, the mean number of notations regarding OE exposures was less than one item per patient chart. A comparison of mean OE notations per chart before versus after introduction of the OHRA indicated a decline in notations after introduction of the OHRA (1.03 vs 0.72, P = 0.02). We detail the type of OE issues that patients presented to a primary care practice and the resulting information contained in primary care providers' notes. Suggestions are made to improve a self-administered patient questionnaire to better diagnose, prioritize, and formulate treatment plans related to OE issues.

Occupational issues in episodic care populations

“…The frequency of findings of responses to our first question dealing with ''work caused'' disease is concomitant with that seen in several other studies [Thompson et al, 2000]. In comparison to private health care facilities, the Los Angeles County facilities have higher proportions of patients not actively employed, but occupational health issues were also noted by those currently employed (Table IIB).…”

“…The current study extends the findings of several prior investigations, which demonstrate that clinicians do not pay sufficient attention to occupational health [Felton, 1980;Schwartz et al, 1991;Milton et al, 1998;Thompson et al, 2000]. The studies have not differentiated the site of care (e.g., continuing care setting vs. episodic care setting).…”

The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices.

“…The environmental history (questions eliciting the parents' concerns and probing potential environmental hazards to which a child is exposed) is readily included in the routine medical history (23)(24)(25). However, medical professionals seldom elicit an environmental history from their patients (26,27).…”

Clinical Awareness of Occupation-Related Toxic Exposure

“…A brief environmental and occupational history [12], which can be obtained through a questionnaire completed in the waiting room [13,14] would have allowed Dr. Franzen to identify and prevent potential further toxic exposures in Mr. Juarez's case. The clinical encounter with Mr. Juarez should be conducted at a level that matches his health literacy.…”