Abstract

Background

Under‐reporting of occupational diseases is an important issue worldwide. The collection of reliable data is essential for public health officials to plan intervention programmes to prevent occupational diseases. Little is known about the effects of interventions for increasing the reporting of occupational diseases.

Objectives

To evaluate the effects of interventions aimed at increasing the reporting of occupational diseases by physicians.

Search methods

We searched the Cochrane Occupational Safety and Health Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, OSH UPDATE, Database of Abstracts of Reviews of Effects (DARE), OpenSIGLE, and Health Evidence until January 2015.

We also checked reference lists of relevant articles and contacted study authors to identify additional published, unpublished, and ongoing studies.

Selection criteria

We included randomised controlled trials (RCTs), cluster‐RCTs (cRCTs), controlled before‐after (CBA) studies, and interrupted time series (ITS) of the effects of increasing the reporting of occupational diseases by physicians. The primary outcome was the reporting of occupational diseases measured as the number of physicians reporting or as the rate of reporting occupational diseases.

Data collection and analysis

Pairs of authors independently assessed study eligibility and risk of bias and extracted data. We expressed intervention effects as risk ratios or rate ratios. We combined the results of similar studies in a meta‐analysis. We assessed the overall quality of evidence for each combination of intervention and outcome using the GRADE approach.

Main results

We included seven RCTs and five CBA studies. Six studies evaluated the effectiveness of educational materials alone, one study evaluated educational meetings, four studies evaluated a combination of the two, and one study evaluated a multifaceted educational campaign for increasing the reporting of occupational diseases by physicians. We judged all the included studies to have a high risk of bias.

We did not find any studies evaluating the effectiveness of Internet‐based interventions or interventions on procedures or techniques of reporting, or the use of financial incentives. Moreover, we did not find any studies evaluating large‐scale interventions like the introduction of new laws, existing or new specific disease registries, newly established occupational health services, or surveillance systems.

Educational materials

We found moderate‐quality evidence that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases compared to no intervention (risk ratio of 1.11, 95% confidence interval (CI) 0.74 to 1.67). We also found moderate‐quality evidence showing that sending a reminder message of a legal obligation to report increased the number of physicians reporting occupational diseases (risk ratio of 1.32, 95% CI 1.05 to 1.66) when compared to a reminder message about the benefits of reporting.

We found low‐quality evidence that the use of educational materials did not considerably increase the rate of reporting when compared to no intervention.

Educational materials plus meetings

We found moderate‐quality evidence that the use of educational materials combined with meetings did not considerably increase the number of physicians reporting when compared to no intervention (risk ratio of 1.22, 95% CI 0.83 to 1.81).

We found low‐quality evidence that educational materials plus meetings did not considerably increase the rate of reporting when compared to no intervention (rate ratio of 0.77, 95% CI 0.42 to 1.41).

Educational meetings

We found very low‐quality evidence showing that educational meetings increased the number of physicians reporting occupational diseases (risk ratio at baseline: 0.82, 95% CI 0.47 to 1.41 and at follow‐up: 1.74, 95% CI 1.11 to 2.74) when compared to no intervention.

We found very low‐quality evidence that educational meetings did not considerably increase the rate of reporting occupational diseases when compared to no intervention (rate ratio at baseline: 1.57, 95% CI 1.22 to 2.02 and at follow‐up: 1.92, 95% CI 1.48 to 2.47).

Educational campaign

We found very low‐quality evidence showing that the use of an educational campaign increased the number of physicians reporting occupational diseases when compared to no intervention (risk ratio at baseline: 0.53, 95% CI 0.19 to 1.50 and at follow‐up: 11.59, 95% CI 5.97 to 22.49).

Authors' conclusions

We found 12 studies to include in this review. They provide evidence ranging from very low to moderate quality showing that educational materials, educational meetings, or a combination of the two do not considerably increase the reporting of occupational diseases. The use of a reminder message on the legal obligation to report might provide some positive results. We need high‐quality RCTs to corroborate these findings.

Future studies should investigate the effects of large‐scale interventions like legislation, existing or new disease‐specific registries, newly established occupational health services, or surveillance systems. When randomisation or the identification of a control group is impractical, these large‐scale interventions should be evaluated using an interrupted time‐series design.

We also need studies assessing online reporting and interventions aimed at simplifying procedures or techniques of reporting and the use of financial incentives.

Author(s)

Stefania Curti, Riitta Sauni, Dick Spreeuwers, Antoon De Schryver, Madeleine Valenty, Stéphanie Rivière, Stefano Mattioli

Abstract

Plain language summary

Interventions to increase the reporting of occupational diseases by physicians

Background

There are many diseases that are caused by work. For example, miners often suffer from lung diseases like pneumoconiosis, whereas eczema is common in hairdressing. Both are commonly referred to as occupational diseases. For workers to receive compensation, therapy or prevention for having developed symptoms because of work, a physician has to officially recognise their condition as an occupational diseases and report it to the appropriate authorities. However, often occupational diseases go unreported. This is because doctors might not know what is expected of them or they feel reporting is too difficult and takes too much time. Because of under‐reporting, occupational disease figures are often not reliable even within a given country. Not knowing the size of the problem, public health officials cannot plan intervention programmes or allocate resources. Many projects have been set up in various countries to improve the reporting of mostly specific categories of occupational diseases.

Review question

What are the effects of interventions aimed at increasing the reporting of occupational diseases by physicians?

Study characteristics

We included 12 studies. Six studies evaluated the effectiveness of educational materials alone; one study evaluated the effectiveness of educational meetings; and four studies evaluated a combination of the two in increasing the reporting of occupational diseases by physicians. A further study evaluated the effectiveness of a complex educational campaign acting at society level. We searched for studies until January 2015.

Results

We found that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases, but a legal obligation reminder message did. Furthermore, we found that the use of educational materials did not considerably increase the rate of reporting occupational diseases. Similarly, we found that the use of both educational materials and meetings did not considerably increase the number of physicians reporting occupational diseases or the rate of reporting. The same holds for the use of educational meetings alone. The use of an educational campaign appeared to increase the number of physicians reporting occupational diseases, although this was based on very low‐quality evidence.

Further research

We need high‐quality studies to clarify the effectiveness of these interventions. This review was unable to determine the effectiveness of interventions other than education like the use of financial incentives, which could be an important form of motivation in changing physicians' behaviour. Such small‐scale interventions could be investigated using larger randomised controlled trials, while the evaluation of large‐scale interventions like legislation should use an interrupted time‐series design.

Author(s)

Stefania Curti, Riitta Sauni, Dick Spreeuwers, Antoon De Schryver, Madeleine Valenty, Stéphanie Rivière, Stefano Mattioli

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

The majority of educational interventions did not show a considerable effect. Conversely, two studies (reported in one article) showed that a reminder message of the legal obligation to report seemed more effective than a simple message about the pros and cons of reporting occupational diseases. Hence, we may conclude that the results of educational interventions are inconsistent.

There was very low‐quality evidence that the implementation of an educational campaign increased the number of physicians reporting occupational diseases compared to no intervention.

There was low‐quality evidence that educational materials alone or in combination with meetings did not considerably increase the rate of reporting occupational diseases.

Implications for research 

We identified a very small number of studies in this review. We judged all of them to have a high risk of bias. Hence, there is a need for high‐quality studies ‐ executed in different countries ‐ evaluating the effects of interventions aimed at increasing the reporting of occupational diseases by physicians.

The interventions evaluated in the included studies mostly consisted of educational materials, educational meetings, or a combination of the two. It is important to conduct high‐quality RCTs regarding these small‐scale interventions. Even the evidence regarding the effect of a reminder message of the legal obligation to report needs to be corroborated by larger RCTs where the legal obligation to report reminder message is compared to usual practice in order to increase the number of physicians reporting. The feasibility of RCTs to study the reporting of occupational diseases is clearly supported by the results of our systematic review, in which the number of included RCTs was higher than included CBA studies.

It should be emphasised that future studies of small‐scale interventions should be customised to the specific type of physician addressed, as in this case it is likely that different interventions could be more suitable depending on the type of physician. Large‐scale interventions are more likely to be addressed to all physicians.

Future studies should also investigate the effect of large‐scale interventions like legislation and existing or new disease‐specific registries activated through a surveillance system. Moreover, the effectiveness of educational campaigns should be further evaluated using robust methodology and well‐designed and well‐conducted studies. The evaluation of these large‐scale interventions should be performed by interrupted time‐series (ITS) study designs where the outcome is measured several times before and after the intervention. Although well‐conducted randomised trials provide the most reliable evidence on the effectiveness of interventions, ITS studies can provide a method of measuring the effect of an intervention when randomisation or identification of a control group are impractical. For example, an ITS study could be used to assess the effect of a new law stating that a new occupational disease can be compensated, by comparing the number of physicians reporting occupational diseases before and after the implementation of the legislation.

Future studies should also consider evaluating Internet‐based interventions, such as online reporting or interventions aimed at simplifying procedures or techniques of reporting. These studies could be evaluated through RCTs and addressed to specific types of physicians.

Lastly, since financial incentives seemed to be effective in changing healthcare professional behaviours in the review by Flodgren 2011, large RCTs evaluating the effect of this intervention to increase the number of physicians reporting occupational diseases compared to usual practice are needed. The target population of this intervention could be general practitioners, since in their practice they are less often exposed to cases of occupational origin. Financial incentives could be an important source of motivation in changing physicians' behaviour.

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