From scientific evidence to operative practice: towards a model of occupational medicine based on on efficacy evidence

摘要

There is increasing interest in improving health care practice and in providing evidence-based health care, that is, care in which different stakeholders consistently consider research evidence when making decisions. Quality of health care is presently viewed as a goal towards which different health care settings are geared. In comparison with this approach and in spite of the large development potentialities, occupational health practice is only at the beginning of the process. ILO convention No. 161 already pointed out the need to provide customers with quality-oriented services and evidence-based services. Occupational health practice can be analysed by means of a general system model already established for health care systems including input (structure, management, personnel, equipment), process (activities, performance), output (advice, recommendation), outcome (good life quality, sickness absence, work ability). All these elements can be critically measured with appropriate indicators to evaluate their efficacy. Despite general agreement about the importance of such analysis, there is a lack of data on the efficacy of prevention programmes. According to the evidence-based medicine model, which is commonly used by many other medical specialties, occupational health physicians could adopt a similar approach in order to implement more efficacious interventions. The evidence-based paradigm consists in the conscientious, explicit and judicious use of available best evidence in making decisions about health care problems. The practice of evidence-based medicine means integrating individual expertise with the best current evidence from systematic research. Evidence-based occupational health should implement this innovative approach to evaluate and to improve the efficiency of prevention services by means of the ability to (i) formulate the questions on the problem; (ii) search for scientific evidence; (iii) critically evaluate scientific evidence; (iv) use evidence as a key element for the decision process.