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The occupational history in the primary care setting
D A Schwartz1, D S Wakefield, J F Fieselmann
1Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City 52242.
The American Journal of Medicine
|March 1, 1991
Summary
Primary care patients frequently report significant occupational exposures. A validated survey effectively identifies these exposures, highlighting the need for occupational medicine services in general medical settings.
Area of Science:
- Occupational Medicine
- Primary Care Medicine
- Public Health
Background:
- Occupational exposures are a significant determinant of health.
- Primary care settings are ideal for identifying potential occupational health risks.
- The prevalence of occupational exposures in primary care patients is not well-established.
Purpose of the Study:
- To determine the prevalence of occupational exposures among primary care patients.
- To assess the need for occupational medicine services.
- To validate a survey instrument for identifying occupational exposures.
Main Methods:
- A survey was administered to 534 patients in a primary care clinic.
- Patients reported exposures to potentially toxic agents.
- Survey validity was assessed by comparing chest radiographs of exposed versus unexposed individuals for asbestos, coal dust, and silica.
Main Results:
- Nearly 75% of patients reported exposure to at least one toxic agent.
- Over 30% reported exposure to four or more agents.
- The survey demonstrated significant association with radiographic changes for asbestos, coal dust, and silica, indicating validity for pneumoconiotic dusts.
Conclusions:
- Patients in ambulatory care settings commonly have significant occupational exposures.
- The developed survey is a valid tool for identifying pneumoconiotic dust exposures and potentially others.
- Findings support integrating occupational exposure assessments into primary care.