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Excerpt
This interesting article describes a useful methodology for determining the applicability and usefulness of various employee surveillance examinations and their components. It was devised by a group of experienced occupational medical physicians in the United Kingdom who were working with eight major international petroleum companies, a British gas company, an automobile manufacturer, and a London medical center. Their rationale is based on and supports the joint premise that: (1) unstructured general medical examinations that are untargeted to any particular risk are not cost-effective and their continuance cannot be supported, and (2) occupational and nonoccupational examinations alike should be tailored to identified or presumed risk, the latter through the use of lifestyle health-risk assessments.
The group defined health surveillance as "a generic term which includes any kind of procedure undertaken-to review an employee's health in order to detect and assess any significant deviation from normality," medical surveillance being a subset of health surveillance, and medical examinations being medical surveillance carried out under the direct supervision of a physician. All health surveillance procedures were placed into one of six categories according to three sets of descriptors: risk-based vs "unfocused"; as representing primary, secondary, or tertiary prevention; and as being occupationally or nonoccupationally related. The resulting schema facilitates an analysis of the aims and objectives of each health procedure, including assessments of utility and cost-effectiveness.
The authors assert that although this approach allows clear identification of objectives (needs) for new or existing procedures, "unless some general health surveillance is established for all workers, new and previously unrecognized work-related illness may be missed...". Because "there is growing evidence that (unfocused) tertiary preventive health surveillance is no longer cost-effective for use in the occupational setting-an alternative is to introduce a risk-based primary preventive approach as exemplified by the used of lifestyle health risk assessments as part of a health promotion program-this is then used as a method for establishing a minimum level of health surveillance for all employees." They point out the need for including elements addressing known risks/exposures ("targeted surveillance"). Also, recognizing the importance of hard data in justifying and managing activities, they state "it is important to be able to produce data to demonstrate continual improvement and to act as the basis for auditing effectiveness. The use of computerized systems will aid this process."
This article will be useful to those occupational physicians who have some difficulty identifying or justifying rationales for the various surveillance exams and procedures they encounter or are considering.
