A stepped health care delivery strategy for optimizing provider-patient discussions of health risk following possible military or occupational exposures.
Engel-CC; Adkins-J; Cowan-D; Riddle-JR
ICOH 2002 Oct; :175-177
Military deployments routinely involve environmental and psychosocial exposures of uncertain health consequence. The Institute of Medicine has recommended and the U.S. Congress now requires that "force health protection" efforts involve detailed environmental monitoring for all overseas tactical troop deployments. These environmental monitoring efforts often produce complex data that necessitate careful population risk communication planning and implementation. An often-overlooked opportunity to convey these data occurs in primary care. Nearly 80 percent of all Department of Defense health care beneficiaries see a primary care provider each year. Therefore, primary care efforts to communicate the health risks of previous deployments offer nearly population-based risk communication coverage provided quality of these communications is ensured. We present a model for maintaining and improving high quality risk communication performance among clinicians providing care for military personnel and veterans with various deployment-related health concerns. The central feature of the model is its reliance on a stepped health care delivery strategy. Patients are "diagnosed" into one of five groups, each with increasing levels of unmet clinical risk communication need (see figure). These groups include patients with 1) no deployment-related health concerns; 2) deployment-related concerns and no illness or disease (Le., "asymptomatic patient with concerns"); 3) deployment-related concerns and recognized disease; 4) deployment-related health concerns with recent onset of medically unexplained symptoms; and 5) deployment-related health concerns with chronic medically unexplained symptoms. The intensity of risk communication efforts increases with progression up the "steps". Department of Defense (DoD) and Department of Veterans Affairs (VHA) medical facilities are using this clinical risk communication strategy in a new practice guideline called the DoD-VHA Clinical Practice Guideline for Post-Deployment Health Evaluation and Management (PD-CPG). Research is underway to develop web-based tools to improve the implementation of this communication strategy in DoD and VHA medical facilities. Future research is needed to determine the model's positive and negative impacts on patients, on health care settings, and on clinicians. Outcomes of particular interest include acceptability of the model for clinicians and for patients, its clinical feasibility, clinician levels of adherence, and capacity of this model to alter outcomes such as patient health status, provider-patient trust, and provider and patient satisfaction with post-deployment health care. In federal health care settings, efforts to protect military forces and their families are examining clinical risk communication strategies with intense interest. These efforts may also be used to inform efforts to provide care and mitigate symptoms and disability in communities during the weeks, months, and years following a terrorist attack.
Health-care; Occupational-exposure; Health-hazards; Environmental-exposure; Environmental-factors; Environmental-health-monitoring; Military-personnel; Health-care-facilities; Health-care-personnel
Abstract; Conference/Symposia Proceedings
Disease and Injury; Research Tools and Approaches; Health Services Research
Best Practices in Occupational Safety and Health, Education, Training, and Communication: Ideas That Sizzle, 6th International Conference, Scientific Committee on Education and Training in Occupational Health, ICOH, In Cooperation with The International Communication Network, ICOH, Baltimore, Maryland, USA, October 28-30, 2002