THE UNION HEALTH-CENTER - A WORKING MODEL OF CLINICAL CARE LINKED TO PREVENTIVE OCCUPATIONAL-HEALTH SERVICES

As health care provision in the United States shifts to primary care s ettings, it is vital that new models of occupational health services b e developed that link clinical care to prevention. The model program d escribed in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the international Lad ies Garment Workers Union (now the Union of Needletrades, Industrial a nd Textile Employees) serving a population of approximately 50, 000 pr imarily minority, female garment workers in New York City. The objecti ve of this paper is to describe a model occupational medicine program in ct union-based comprehensive health center linking accessible clini cal care with primary and secondary disease prevention efforts. To ass ess the presence of symptoms suggestive of occupational disease, a hea lth status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this s urvey an occupational medicine clinic tvas developed that integrated d irect clinical care with worker and employer education and workplace h azard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a charr review was co nducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed report ed symptoms indicative of occupational illnesses. However only 42 (4%) reported having been told by a physician that they had are occupation al illness and only 4 (.4%) reported having filed a workers' compensat ion claim for art occupational disease. In the occupational medicine c linic established at the UHC, a health and safety specialist acts as a case manager; coordinating worker and employer education as well as w orkplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index case s of rotator cuff tendonitis, lead poisoning, and formaldehyde overexp osure in three patients and their preventative work place follow-up, a ffecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic o peration included cumulative trauma disorders (141 cases), carpal tunn el syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project repr esents a new model for effective integration of clinical care and occu pational disease prevention efforts within a primary care center it co uld serve as a prototype for development of such services in other man aged and primary care settings. (C) 1997 Wiley-Liss, Inc.