265672 Return to work patterns for those with occupational respiratory disease: Clinical and structural factors

Sunday, October 28, 2012

Jeanette Zoeckler, MPH , Occupational Health Clinical Center, SUNY Upstate Medical University, Syracuse, NY
Donald Cibula, PhD , Center for Research and Evaluation, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
Christopher P. Morley, PhD , Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY
Michael B. Lax, MD MPH , Family Medicine SUNY Upstate Medical University, Central New York Occupational Health Clinical Center, Syracuse, NY
BACKGROUND Workers who have become ill or injured at work typically follow a jagged progression to a “new normal” status. “Return to Work” research has focused primarily on musculoskeletal injuries with very little attention paid to respiratory disorders. Much of this research has emphasized the role of psychological and other personal factors with little attention paid to the broader social context. This study sought to identify both personal and structural factors that impact the ability of workers with work related respiratory disease to return to work. METHODS A retrospective chart review followed patients with work-related respiratory disease at an Occupational Health Center for two years using a sequential mixed methods research design. Multinomial (n=188) and Cox regressions (n=130) assessed predictors of work status outcomes. A subset (n=21) were selected for in-depth interviews. RESULTS Return to work time was improved for union members and for patients who came to the clinic soon after disease onset. Outcomes were worse for individuals with multiple diagnoses. Interviews demonstrated difficulties navigating the complexity of recovery. Disease severity and adversarial employer actions impeded successful return to work. Controlling harmful exposures proved difficult. CONCLUSIONS The study results have implications for all participants in the return to work process. Exposure controls and facilitated access to occupational health services would likely reduce disease severity and improve return to work rates. Improving employers' responses to workplace respiratory illnesses, and recognizing the beneficial role of unions are additional potentially beneficial steps.

Learning Areas:
Occupational health and safety

Learning Objectives:
Learning Objectives 1. Identify prognostic factors and mechanisms which influence work status outcomes for patients with work-related respiratory disease. 2. Describe common assumptions found in Return to Work literatures. 3. Characterize the most prominent findings in Return to Work literatures. 4. Distinguish between nine Return to Work patterns identified by the study. 5. Consider the merit of creating a diagnostic composite as a research method. 6. Assess relative contribution of co-variates to work status outcomes for this patient population when using Multinomial Logistic Regression and Cox Regression Models. 7. Identify themes deemed important by worker/patients experiencing work related respiratory illness. 8. Assess the relative strengths of mixed methodology as it was applied in this multidisciplinary, exploratory study (medical chart review followed by in-depth interviews). 9. Inter-relate quantitative and qualitative results. 10. Re-appraise return to work expectations for patients with work-related respiratory illness. 11. Design research to confirm/refute evidence for these prognostic factors. 12. Evaluate the translational effect of mixed methods research, especially as applied to “return to work.” 13. Explain implications of this study with regard to potential policy and programming changes in occupational health clinical settings.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a research assistant for three years working on projects related to occupational health, focusing on the interrelationship between psychological and biomedical factors. I co-designed and conducted all phases of this study as the project's main consultant, under the direction of the Principal Investigator at the Occupational Health Clinical Center, Syracuse, NY.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.