1. Conclusions and recommendations
Occupational physicians’ views on barriers and facilitators in occupational disease reporting in the Netherlands
AF Lenderink, ITJ Braam, F Moeijes, HF van der Molen, PBA Smits, PPFM Kuijer,
JG Bakker, B Sorgdrager, D Spreeuwers
Netherlands Centre for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
Background & Aim 1
Methods 2
Studies suggest strong underreporting of occupational diseases (ODs) in industrialized countries. Although Dutch occupational physicians (OPs) are legally obliged to report ODs, there is considerable and growing underreporting in the national registry, especially in sectors outside the Construction sector.
Since 2005 there have been major changes in the Dutch Occupational Health and Safety (OSH) legislation which influenced the way OHS is organized. This may have changed the daily practice of OPs and could, among other things, have impact on the recognition and reporting of ODs.
An online questionnaire was mailed in March 2011 to OPs registered with the Netherlands Center for Occupational Diseases (NCOD): 562 of 1773 OPs (32%) participated in the survey.
OPs were asked to rate their opinion on a set of predefined and theoretically based statements on:
1. Reporting of ODs in general
2. Possible reasons for decreased reporting since 2001
3. Factors that stimulate reporting in their own work setting
We included the following predefined statements:
The numbers of ODs and work-related diseases have decreased since 2000;
The number of workers who consult an OP has decreased since 2000 (because of sick leave; questions on work-relatedness of health problems or a periodic check-up);
Not all workers who suspect a work-related health problem consult or are able to consult an OP;
OPs lack knowledge, ability and opportunity to recognize and diagnose ODs or work-related diseases;
Recognizing, diagnosing and reporting ODs and work-related diseases are no explicit tasks in contracts of Occupational Health Services with companies and organizations;
Recognizing, diagnosing and reporting ODs and work-related diseases are no explicit subject in quality audits by government, supervisor, clients, or professional organizations of OPs.
The aim of this study was to identify Occupational Physicians’ views on how changes in the way Occupational Health and Safety is organized in the Netherlands may have affected the reporting of occupational diseases towards the Dutch National Registry.
Results 3
1. Reporting of ODs in general
OPs consider continued vigilance for health problems caused by work or work situation important;
ODs and work-related disease are considered a signal that something is wrong at the workplace
Many OPs consider the way OHS services are organized since 2005 as a barrier to the recognition of ODs;
Dutch OPs are no strong supporters of the introduction of a workers’ compensation system or ‘risque professionel’
2. Possible reasons for decreased reporting
In OPs’ work settings the focus is on ‘return to work’ activities rather than on prevention;
OPs identify increased barriers in the contact between workers and OPs, partly because of changes in the Dutch OSH legislation;
Those OPs working in Occupational Health Services have to deal with an increased work load, partly due to budget cuts;
3. Factors that stimulate reporting in work setting
OPs are motivated mainly intrinsically, by their professionalism and increasing knowledge;
OPs are stimulated to report because it’s their legal duty;
OPs appreciate feedback and facilitation of reporting in time and technology (easy access to reporting system);
The influence of others (supervisors, colleagues, clients, workers is considered less important as stimulants.
Conclusions and recommendations 4
The number of remedial approaches which the NCOD can apply is limited, but should focus on supporting and enhancing professionalism by further professional education, relevant knowledge transfer, simple electronic reporting, and the development of registration guidelines. Nevertheless improvement calls for a collaborative effort of all responsible parties and warrants further research to guide policy and practice.