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Practice Patterns of Pulmonologists and Family Physicians for Occupational Asthma^*

^* From Gage Occupational and Environmental Health Unit, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada.

Correspondence to: D. Linn Holness, MD, FCCP, Gage Occupational and Environmental Health Unit, St Michael’s Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; e-mail: HOLNESSL{at}smh.toronto.on.ca

Abstract

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.

Key Words: barriers • education needs • exposure history • medical education • occupational asthma • occupational history • occupational lung disease • referral patterns