Analysis of the health status of medical workers based on the results of mandatory periodic examinations

Introduction

At present, certain successes have been achieved in the field of labor protection of health workers, but despite this, there is still no single organizational system of occupational safety, which would include scientific research on these problems [1].

Hygienists who exercise external control over working conditions, as well as the authorities of healthcare organizations, do not pay due attention to the occupational safety and health of medical staff, underestimating the degree of danger of the hospital environment as an occupational risk factor. The doctors and nurses themselves do not, probably, attach much importance to solving this problem because traditionally the health maintenance policy was performed mainly for patients, and not for employees. The lack of attention to their health can also be explained by the fact that they are considered to be professionals who are able to take care of their health without anyone's help [2]. Meanwhile, health workers are unfairly assigned to the most favorable group in terms of working conditions [3]. When studying the health status of health workers, high rates of morbidity, high mortality, and low life expectancy were revealed. One of the reasons for such consequences might be a more severe course and poor prognosis of diseases in health workers, which might be associated with certain features of the health profession [4][5][6]. At present, there are no clear rules or recommendations on occupational safety applicable to all aspects of work in healthcare organizations, and most of the existing recommendations are nonspecific. Regardless of the specialization of hospitals, there are common unfavorable factors of the working environment, such as neuro-emotional stress, chemicals, biological agents, high voltage of analyzer systems, the possibility of injury, and the daily work schedule that disrupt the biological rhythm [7].

The system of preliminary and periodic medical examinations (PMEs) plays a crucial role in the health maintenance of medical staff. One of the main efficiency criteria of preventive medical examinations is the number of detected diseases, both occupational and general ones [8].

The research was aimed at the analysis of the PME results of employees of a large healthcare organization in dynamics, according to the final acts.

Materials and methods

The research studied the final acts (2019–2021) compiled based on the PME results of employees of the State Budgetary Institution of Healthcare of the Novosibirsk Region "State Novosibirsk Regional Clinical Hospital for War Veterans". Data on the structure of diseases for 2019–2021, which health workers treated in the day hospital, were also analyzed.

PMEs were performed at the basis on State Novosibirsk Regional Clinical Hospital for War Veterans in 2019 and 2020 in accordance with the Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n (as amended on May 18, 2020) “On approving the lists of hazardous and (or) dangerous occupational factors and works that require mandatory preliminary and periodic medical examinations (workup) and on Regimen of mandatory preliminary and periodic medical examinations (workup) for workers exposed to intense labor and to hazardous and (or) dangerous work conditions”. In 2021, PMEs were performed in accordance with the Order No. 29n “On approval of the Regimen of mandatory preliminary and periodic medical examinations for workers as provided for by part four of article 213 of the Labor Code of the Russian Federation, the List of medical contraindications for work with hazardous and (or) dangerous occupational factors and works that require mandatory preliminary and periodic medical examinations (workup)” dated January 28, 2021.

Results

In just three years, 546 employees underwent PMEs, of which 489 were women. Data based on the results of the analysis of the final acts in dynamics for 2019–2021 are presented in Table 1.

As Table 1 shows, in 2019, according to the PME results, no persons were identified who needed additional examination, inpatient and sanatorium treatment, as well as a regular medical checkup. Eleven people, i.e., only 6% of the total number of those examined, were identified who needed outpatient treatment. In 2020, 22 people (12%) needed outpatient treatment, 4 people (2%) – inpatient examination and treatment, and 36 people (20%) – sanatorium treatment. In 2021, the situation changed dramatically. The group of people in need of additional outpatient examination and treatment amounted to 43 people (22%), in need of inpatient examination and treatment – 3 people (1.6%), in need of sanatorium treatment – 125 people (65%), and in need of regular medical checkup – 110 people (57%).

The research results have demonstrated that in the dynamics of a three-year observation, the number of persons who could be subject to additional examination, treatment, and a regular medical checkup has sharply increased, which might indicate a certain PME efficiency.

In the next stage, the structure of newly diagnosed chronic somatic diseases in dynamics for 2019–2021 was analyzed. The results are presented in Table 2.

If general morbidity with a temporary disability is considered, then a health worker (primarily a doctor) often does not record it in the relevant documentation, which is why it does not fall into the statistical data. In case of chronic diseases without disability or with minor impairments that allow them to be engaged in predominantly intellectual work (medical diagnostic process, pharmaceutical activity), doctors do not apply to their colleagues, self-medicate, and do not fall into the general statistics [9].

Table 2 shows that in 2019–2020, there was an extremely low detection rate of chronic somatic diseases, according to the PME results. So, in 2019, it was 2%, in 2020 – 1.7%, and in 2021 – 16%, which was 10 times more than in previous years. In the structure of newly diagnosed chronic somatic diseases, diseases of the endocrine system, eating disorders, and metabolic disorders predominated.

The program for the prevention and rehabilitation of doctors, along with the PME system, includes the organization and provision of preventive treatment in a day hospital.

Trufanova and Poteryaeva (2018) [10], when questioning doctors of a large multidisciplinary hospital, revealed the main measures for improving the organization of medical care for them: 75.4% of doctors noted preventive treatment at the workplace two times a year, 68.8% indicated provision of the possibility of rehabilitation treatment on the basis of the physiotherapy department; 70.7% noted formation of specialized district offices and specialized receptions for unscheduled visits of health workers; 56.2% of doctors positively assessed the creation of a psychological relief room, the possibility of individual psychological correction and group psychological consultations.

Sixty-nine health workers underwent treatment on the basis of the day hospital of State Novosibirsk Regional Clinical Hospital for War Veterans over 3 years. The structure of diseases over a three-year period is presented in Table 3.

The presented table demonstrates the dynamics of a sharp increase in the number of health workers who underwent treatment and rehabilitation in a day hospital, mainly due to patients with the consequences of a new coronavirus infection COVID-19.

Conclusion

When analyzing the final acts of employees of the State Novosibirsk Regional Clinical Hospital for War Veterans based on the PME results for the period from 2019 to 2021, it has been found that the efficiency and quality of examination have increased dramatically. In dynamics, the number of persons who needed additional examination, treatment, and a regular medical checkup has increased. Also, over a three-year follow-up period, the detection rate of chronic somatic diseases in health workers increased by more than 10 times. This was the reason for sending employees for medical examination and treatment in a day hospital. The number of health workers who have been examined and treated in the day hospital of the State Novosibirsk Regional Clinical Hospital for War Veterans has increased over a three-year follow-up period by more than 5 times.

Early detection of the first signs of occupational and somatic diseases at the stage of PME, their treatment in a day hospital can reduce both the number of occupational diseases and the progression of general diseases to severe forms with disability of patients.

Authors’ contribution:

E.A. Golovko, E.L. Poteryaeva — research design development;

I.A. Nesina — data acquisition and analysis;

E.L. Smirnova — writing the text of the manuscript;

N.N. Figurenko, K.O. Demeshko — review of publications on the topic of the article.

Conflict of interest. Authors declares no conflict of interest.