Chest
Volume 132, Issue 5, November 2007, Pages 1526-1531
Journal home page for Chest

Original Research
ASTHMA
Practice Patterns of Pulmonologists and Family Physicians for Occupational Asthma

https://doi.org/10.1378/chest.06-2224Get rights and content

Background

The longer the duration of symptoms of occupational asthma (OA) before diagnosis, the poorer the outcome. Physicians can play a key role in the early recognition of occupational lung diseases (OLDs), including OA. Our objective was to document and compare the practice patterns, barriers, and needs for early diagnosis of OA among pulmonologists and family physicians.

Methods

Based on information from the literature and interviews with pulmonologists and family physicians, a survey was developed to obtain information on practice patterns. The survey was sent to all pulmonologists and a random sample of 600 family physicians in Ontario.

Results

Eight percent of pulmonologists and 7% of family physicians report seeing > 20 patients a year with OLD. The majority report taking a workplace exposure history. The most commonly stated barrier to obtaining a workplace exposure history was time constraints. Main reasons for referral to specialists for diagnosis include personal lack of expertise, testing facilities, and knowledge about workers' compensation, while lack of timely access to specialists is a barrier for referral. While most physicians identified a need for further education, those who did not identify a need for further occupational respiratory education cited low volume of patients, access to specialists, and time constraints as reasons for not wanting further education.

Conclusions

Opportunities are identified to improve health services delivery and educational initiatives for OA, with approaches tailored to each particular physician group.

Section snippets

Materials and Methods

The study was reviewed and approved by the Research Ethics Board of St. Michael's Hospital, as part of a larger study26 that also examined dermatologist and family physician practice related to occupational contact dermatitis. To inform the content of the survey instrument, phase 1 consisted of interviews with pulmonologists and family physicians. The interviews were conducted by a consultant in medical education with much experience in interviewing physicians. Four pulmonologists and two

Results

Demographic information is presented in Table 1. The majority of respondents practiced in large urban or metropolitan areas, were men, and were < 50 years old. Fewer than 10% of pulmonologists and family physicians reported seeing > 20 patients per year with occupational lung disease (OLD). There were no significant differences between the two groups with respect to age, gender, or year of graduation, but there was a significant difference in practice setting, with family physicians being more

Discussion

Although response rates were low in this survey, they were in keeping with, or better than, that reported in a similar study of members of the American College of Chest Physicians by Harber et al25 (response rate, 25.5%). Our response rate from pulmonologists was 49%, and 26% for family physicians. The demographics of the respondents to the survey are similar to those of the total respective groups of Ontario physicians. The Canadian Medical Association reported that 25% of pulmonologists were

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    This work as performed at Gage Occupational and Environmental Health Unit, St. Michael's Hospital, University of Toronto.

    This project was funded by a research grant from the Ontario Workplace Safety and Insurance Board, project 02036.

    Drs. Holness, Tarlo, Liss, and Silverman receive research grant support from the Ontario Workplace Safety and Insurance Board. Ms. Tabassum and Mr. Manno have no conflicts of interest to disclose.

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