Should occupational lung clinics incorporate a return to work coordinator or an occupational hygienist?

This is an interesting paper comparing two clinics run by the same physician; in one patients seeking compensation are seen usually once only by a multidisciplinary team including an occupational hygienist who takes the exposure history, and a return to work coordinator who handles communication between the clinicians and the workplace, visits the workplace if necessary and facilitates redeployment; the other clinic follows up workers and has a respiratory therapist who educates workers about their treatment, compliance and disease management.
The paper compares mainly psychological factors of anxiety and depression, and asthma quality of life and work limitation all by questionnaires between the two clinics. The data was collected prospectively in a retrospective cohort initially seen between 1991 (or 2002 in one clinic) and 2014, importantly including both those thought to have occupational asthma and those judged to have work-exacerbated asthma. The problem related to the numbers; there were 166 eligible workers. Even assuming a 2002 start for both clinics this is only 14 workers a year, or about one every 2 months per clinic. They collected data on only 46% of these. Workers seen in the compensation clinic lost more money, but had better psychological status and importantly well all removed from the original provoking agent.

References

	Lipszyc JC, Silverman F, Holness DL, Liss GM, Lavoie KL, Tarlo SM, Comparison of clinic models for patients with work-related asthma , Occup Med, 2017;67:477-483,https://doi.org/10.1093/occmed/kqx100

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