OCCUPATIONAL MEDICINE AT OCCUPATIONAL MEDICINE AT THE OHIO STATE - - PowerPoint PPT Presentation

OCCUPATIONAL MEDICINE AT OCCUPATIONAL MEDICINE AT THE OHIO STATE UNIVERSITY THE OHIO STATE UNIVERSITY

Eric Schaub MD Eric Schaub MD Chief, Division of Occupational Medicine Chief, Division of Occupational Medicine The Ohio State University The Ohio State University

Occupational Medicine Perspective

• Why focus on work related injuries?
• Discuss the interaction between work-related

and non work-related conditions

• Work related back pain evaluation
• Diagnosis under BWC
• Expected time course
• Evaluation of work ability
• Vocational rehabilitation
• Maximum medical improvement
• Disability

Work Injuries and Primary Care

• In a national sample of ambulatory work injury

care, Family Medicine provided 22% of care for work injuries, second only to Orthopedics (37%)

• Internal Medicine 8.9%
• Occupational Medicine 7.5%
• Represent 2.5% of all visits to Family Medicine
• Most visits were acute (55.3%) and for

musculoskeletal conditions (46.5%)

• Won and Dembe, Annals of Family Medicine 2006

Work and Non-work related Interactions

• Traditionally work and non-work related risk

factors and conditions have been dealt with as separate entities

• Payment issues
• Liability issues
• Epidemiology has dealt with single risk factors

with other risk factors as confounders (“nuisance”)

• Organizations and society are now starting to

consider disability costs and worker retention

Schulte et al, AJPH 2012

Work and Non-work Interactions

Age WRMSD Occupation Injury Age and occupation are both risk factors for work related musculoskeletal disorders Age is not synonymous with disease although linked to risk Retirement ages (as a society) are being evaluated due to financial burden

• f retirees (dependency ratio)

Schulte et al, AJPH 2012

Physical job demands Age

Work and Non-work related interactions

• Genetics
• Smoking and occupation
• Shift work
• Professions
• Medications
• Statins and sprains/strains/dislocations
• Fluoroquinolones and tendinopathy
• NSAIDs/WRMSD and adverse effects of NSAIDs
• Schulte et al, AJPH 2012; Khaliq and Zhanil, Clin Inf Dis 2003; Mansi et al JAMA Intern Med

2013

Worker’s Compensation in the State of Ohio

• Diagnosis driven
• ICD code
• Assigned at initial visit (ED, PCP, Occ Med)
• Additional ICD codes – have to be formally

added

• Reasonable medical probability
• Related to the work injury
• Direct causation
• Substantial aggravation
• Flow-through
• Temporal association does not equal causation

Work related low back pain

• Diagnosis under BWC
• Diagnosis, not symptoms
• Supporting information
• Lumbar/lumbosacral strain
• Lumbar radiculopathy
• Spondylosis/spondylolisthesis/lumbar stenosis

Time Course

• Sprain/strain – 8 to 12 weeks
• Other medical conditions
• Depends on diagnosis and treatment
• Claim inactivation – 12 months
• Settlement of claim

Evaluation of work ability

• History
• Usual activities
• “Typical” tolerances
• Physical therapy (history and notes)
• Functional capacity evaluation (FCE)
• Therapist monitors physiologic measures and

stops if there is risk of injury

• Self limitation

Vocational Rehabilitation

• Work conditioning/hardening
• FCE
• Gradual return to work
• Job search skills
• Living maintenance payments
• Bureau of Vocational Rehabilitation

Maximum Medical Improvement

• “Treatment plateau at which no fundamental

change is expected in spite of medical treatment”

• Treatment is permitted
• Supportive, not resorative
• Temporary total disability is stopped
• Different than permanent total disability (PTD)

Disability

• Definition varies
• Gainfully employable (BWC)
• Meets predefined criteria (SSDI)
• Able to return to former position of employment
• Disabled under one definition and not disabled

under another definition

Summary

• More attention to interaction of work and non-

work interactions

• Be aware of diagnosis – work related, formally

added

• Address work ability at every visit
• Be aware when a referral needs to be made for

vocational rehabilitation

• Issues to consider include MMI and

disability/ability

Questions?

• eric.schaub@osumc.edu