Occupational health care personnel tackling alcohol overuse - an observational study of work processes and patient characteristics.

BACKGROUND: Overuse of alcohol is a significant risk factor for early retirement. This observational study investigated patient characteristics and work processes in occupational health care (OHC) affecting practices in tackling alcohol overuse. METHODS: The data were from 3089 patient contacts gathered for quality improvement purposes in fifteen OHC units during the years 2013-2019 in Finland. A two-proportion z-test was performed to find associations between reason for contact, and 17 other factors, and the probability of alcohol use being checked and overuse tackled. RESULTS: OHC personnel checked alcohol use twice as often with male patients as with female patients. Employees at risk of needing sick leave were checked for alcohol use more often (55.4, 95% confidence interval 49.2-61.6%) than those on > 30-day sick leave or working with permanent work disability (p < 0.01). Alcohol use was checked in 64.1% (59.5-68.7%) of patients while making an individual health promotion plan compared to 36.9% of those without a plan (33.1-40.6%, p < 0.0001). Patients with depression were actively checked for alcohol use, especially in cases of major depression (72.7%, 64.0-81.0%). Work processes in which OHC should have been more active in checking and tackling alcohol use included assessing the need for rehabilitation (36.5%, 32.0-41.0%) and health check-ups (HCUs) for mental reasons (43.8%, 38.1-49.4%). HCUs where alcohol overuse was detected led to brief interventions to tackle the overuse in 58.1% (43.4-72.9%) of cases. CONCLUSIONS: The study showed factors that increased OHC personnel's practices in checking and tackling alcohol use and work processes where the activity should be improved. Discussions about alcohol use took place more often with working-aged men than women, the younger the more. OHC personnel checked actively alcohol use with patients in danger of sick leave, patients treated for depression, while making an individual health promotion plan, and in planned HCUs with a confirmed protocol. More improvement is needed to conduct brief interventions in disability prevention processes, and especially when overuse is detected.

Networking of occupational health care units promotes reduction of permanent disability pensions among workers they care: A register-based study controlled by benchmarking with a 5-year follow-up.

OBJECTIVES: Early retirement due to disability is a problem in Finland. That causes pension costs that are heavy for the society. This study was designed to find out whether a quality network can support the reduction in incident disability pensions and promote a shift from full to partial disability pensions. METHODS: The study population (N = 41 472 in 2016) consisted of municipal employees whose occupational health care (OHC) was provided by the members of the Finnish Occupational Health Quality Network (OQN). The comparison population consisted of all municipality employees whose OHC was provided by non-members of the OQN (N = 340 479 in 2016). The outcomes were measured by comparing the trends in incident disability pensions of full and partial permanent pension and full and partial provisional pension, partial/full pension indexes from 2011 to 2016 according to the principles of Benchmarking Controlled Trials. Linear regression models were used to explore the dynamics of different pension forms. Regression coefficients were calculated to show the average change per year. RESULTS: The incidence of permanent disability pensions decreased faster in the study population (P for trend .03) and the study group showed a stronger shift from full to partial permanent pensions (P for trend <.001). CONCLUSION: Quality networking between OHC units including common goal setting, systematic quality improvement, and repeated quality measurements decreased new permanent disability pensions and increased partial permanent pensions. Such changes are important while thriving for increased work participation.

A Personalized Care Plan Is Positively Associated With Better Clinical Outcomes in the Care of Patients With Type 2 Diabetes: A Cross-Sectional Real-Life Study.

OBJECTIVES: Our aim in this study was to determine whether the use of a personalized care plan is associated with better clinical outcomes of type 2 diabetes treatment in the real world. METHODS: Quality of treatment was assessed using data from a yearly sample of patients with type 2 diabetes visiting primary care health centres in 2012-2016. Patients were divided into 3 groups as follows: 1) the patient has a copy of their personalized care plan, 2) the care plan exists in the patient record only or 3) the patient has no care plan. Data on smoking, laboratory tests, systolic blood pressure (sBP) and statin use were collected. We compared the outcomes between the 3 groups in terms of proportions of patients achieving the clinical targets recommended by international guidelines. RESULTS: Evaluable data were available for 10,403 patients. Of these, 1,711 (16%) had a copy of their personalized care plan, and 3,623 (35%) had no care plan. Those patients who had a copy of their care plan were significantly more likely than those without to achieve the sBP target (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.29 to 1.51; p<0.001; adjusted for age and gender) and low-density lipoprotein target (OR, 1.46; 95% CI, 1.34 to 1.58; p<0.001), and to use statins (OR, 1.70; 95% CI, 1.57 to 1.85; p<0.001). CONCLUSIONS: Patients who had a copy of their care plan had a better control of sBP and low-density lipoprotein, and were more likely to use statins than patients without a care plan.

[Quality of treatment of atrial fibrillation patients and indicators utilized in monitoring--results of quality assessment at eleven healthcare centers]. / Eteisvärinäpotilaiden hoidon laatu ja seurannassa käytettävät indikaattorit.

BACKGROUND: Several studies indicate a great need for improvement in the care of atrial fibrillation (AF). Failures in antitrombotic treatment can result in stroke. MATERIAL: A sample of consecutive patients with AF was gathered from eleven health centers (1,156 patients). RESULTS: 57.5% of all warfarin-treated patients (N = 1 125) were in good balance of anticoagulation. Of patients who had INR (International Normalized Ratio) for a period of at least 90 days (N = 531), 75.3% were in good balance. Severe symptoms of AF were experienced by 5.0% of patients. CONCLUSIONS: Treatment of AF has to be improved, especially in anticoagulation. Anticoagulation should simply be stopped or new anticoagulants should be used, if intensifying of warfarin treatment is not successful.