Usefulness of a 'workplace prescription' as a resource for return-to-work

Workers with occupational contact dermatitis often require workplace modifications to stay-in their original job or to return to their original job after an absence from work or a modified work placement. Poor communication of these needs between the worker, workplace, and clinician can be a barrier to a successful outcome. The multidisciplinary team from the Occupational Medicine Clinic at St. Michael's Hospital developed the ‘Workplace Prescription’ (WP) tool (Figure 1) to facilitate the communication of information about recommended workplace modifications in an understandable standardized format to workplace parties involved in the return-to-work process.1 This study sought to gain information about its usefulness from the worker's perspective. The study was approved by the Research Ethics Board of St Michael's Hospital in Toronto, Canada. Fifty participants with occupational contact dermatitis were recruited from the Occupational Medicine Clinic at St. Michael's Hospital. A WP was prepared for each worker and two copies of the WP outlining the recommendations for stay-at-work/return-to-work were given to the worker; one for their personal records and one for their employer. Participants completed a follow-up phone survey 6–8 weeks following their final visit to assess its value. The mean age was 46 (range 23–63) and 52% were male. The most common industries included healthcare (38%), manufacturing (34%) and services (10%). Sixty percent of participants reported having lost time from work at some point during the course of their dermatitis (median 14 days). Forty-five (90%) participants returned to the workplace. At the time of their assessment 26 (58%) were at work in a modified job (e.g. clinical worker doing administrative work), 10 (22%) were not at work and 9 (20%) were at their original job. Of the 45, 39 (86%) took the WP to the workplace, and shared it with Occupational Health and Safety personnel, their manager and/or human resources. Of those returning, 86% described the WP as well-received, or received without issue, by the workplace. In contrast, 14% described unsupportive responses from their employers. Qualitative feedback from participants is summarized in Table 1. Workers report that in 95% of instances, recommendations from the WP were at least partially implemented, and in 70% of instances, the recommendations were completely implemented. The WP was considered valuable by 91% of respondents. Thirteen respondents described the WP as a simple and clear resource to reference for restrictions and recommendations. The most common suggestions for improvement included providing more space for comments and ensuring the workplace implements the recommendations. Implementation: ‘No issues and implemented all the modifications’ ‘Positively—employer has asked me to be point of contact for other workers; I am considered an example of best practices, I speak to colleagues about my experience’ ‘Clear instructions appreciated’ ‘Partial recommendations’ ‘They said they would deal with it but I still have to provide my own cleanser and cream’ ‘Manager supported but infection control having a hard time getting the recommended products’ No implementation: ‘They ignored the WP and responded with threats and harassment’ ‘Dismissive response—this is not poisonous gas’ ‘Addressed all issues’ ‘Handy reference as a reminder of my restrictions’ ‘Easy to follow’ ‘Very, very simple to read It was helpful more so for me by outlining what I can/cannot do at work and to have a reference document’ ‘It was good to have something in writing from doctor to give’ ‘Gives you ammunition when speaking to the employer, anything in writing helps’ ‘The WP was fine but it seemed the company was not obligated to follow it’ ‘Every patient with occupational skin disease should receive it and give it to the workplace (the workplace needs instructions)’ ‘More space for notes/suggestions’ ‘It's good how it goes through everything’ ‘Maybe have a copy sent direct to the workplace and doctors involved’ ‘It is straightforward’ The WP facilitates the communication of specific guidance from the physician to the employer to help a worker either stay in their original job or return to their original job, and serves as an interface for professional advocacy in the workplace on behalf of the worker. The majority of workers were from the healthcare and manufacturing sectors representing larger workplaces that may be better resourced to accommodate the recommendations. Benjamin DeKoven: Writing – review and editing; formal analysis; writing – original draft. Pilar Gomez: Conceptualization; methodology; writing – review and editing. Irena Kudla: Conceptualization; methodology; writing – review and editing. Joel DeKoven: Conceptualization; methodology; writing – review and editing. Sandy Skotnicki: Conceptualization; methodology; writing – review and editing. D. Linn Holness: Conceptualization; writing – original draft; methodology; writing – review and editing; formal analysis; supervision. The authors declare no conflicts of interest.