Aim: To study the current quality of occupational
health care in German hospitals and
compare it with the situation in 1986.
Methods: In 2006 we repeated a survey of
occupational health care units in German
hospitals with more than 500 beds which was
first carried out in 1986. The questionnaire
covered type and intervals of occupational
health check-ups and workplace inspections,
vaccinations and tuberculosis monitoring. In
addition, it was of interest whether the hospitals
offered opportunities for doctors to
specialize in occupational medicine. The potential
structural predictors of quality which
were tested in multivariate regression analysis
included the commercial binding of the
occupational health care units to the hospital,
the number of employees monitored, the
type of hospital and the specialization of the
occupational physician.
Results: In total, 155 questionnaires (59 %)
were returned and analysed. In 80 % of the
hospitals, detailed workplace inspections
take place every one or two years and occupational
health check-ups on average every
three years. Relevant health check-ups are
offered as a rule at the initial examination
and at most of the follow-up examinations.
Vaccinations against hepatitis B, hepatitis A
and influenza are “standard” (> 90 %), whereas
measles, mumps, rubella, varicella, tetanus,
poliomyelitis and pertussis vaccinations are
offered only by 53–63 %. Because of the lack
of valid documents, total immunization rates
of the personnel could not be determined.
Most important negative predictors for
whether certain vaccinations are offered are
the lack of a specialist occupational physician
and an external company status of the occupational
health care units.
Conclusions: Despite some recognizable
deficits, occupational health care quality
in large hospitals is satisfactory and much
better than twenty years ago. Further epidemiological
research is needed to assess
the quality of occupational health care in
smaller enterprises (hospitals, practices,
nursing homes, home care) in the health care
sector. In some respects, the quality of care
offered is good (hepatitis B/A and influenza
vaccination, routine relevant occupational
medical examinations, and inspections of
high risk workplaces). The situation here is
clearly better than twenty years previously.
However, the unsatisfactory response rate
and the higher proportion of external company
services in the group of non-responders
suggest an overestimation of the quality. Improvements
are needed with respect to the
prevention of certain infectious agents as
well as the time interval between and the
extent of follow-up examinations. The deficits
in the possibilities for specialization of
occupational physicians in large hospitals
will weaken occupational medicine in the
future.
Further investigations of the quality of
occupational medical care in smaller enterprises
(small hospitals, practices, in-patient
and out-patient geriatric care) are necessary
to assess the entire situation in the health
care sector.
