Chronic pulmonary diseases of self employed in the craft trade and services sector
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Chronic Pulmonary Diseases of self-employed in the craft, trade and services sector. Doctor Philippe Ha-Vinh Expert physician advisor in health studies diffusion at the French national retirement and health insurance fund for self-employed people in craft, trade and services,

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Chronic Pulmonary Diseases of self-employed in the craft, trade and services sector.

Doctor Philippe Ha-Vinh

Expert physician advisor in health studies diffusion

at the French national retirement and health insurance fund

for self-employed people in craft, trade and services,

A public statutory Health Care Insurance Fund

Régime Social des Indépendants (RSI)

France

Palazzo Moroni Room Anziani

Session: 15- Work related diseases and injuries II

Time for presentation: 15 mn (10+5 discussion)

Eumass 14-16 June 2012, Padova, Italy

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Occupational factors

Hairdressers [Blainey, 1986 ; Leino, 1997]

Bakers [Houba, 1998]

Tailor, seamstress [Wang,2005; LeVan, 2006]

are exposed to occupational

Chronic Pulmonary Diseases

Car repairers [Bener, 1998]

Dental prosthetists [Hu,2006]

Woodworkers [Carosso, 1987]

Taxi drivers [Bener, 1998]

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The rsi who is insured to the rsi

The RSIWho is insured to the RSI ?

  • The RSI was born in 2006 from the merging of three social insurance funds. It is the mandatory health care and retirement fund for the self employed in crafts, trades and services.

  • It is entitled to a public mission in managing the social security for more than 4 million people.

  • It is one of the three main statutory social security schemes in France, the two others being the salaried scheme (CNAMTS) and the agricultural scheme (MSA).

CNAMTS

MSA

RSI

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Goal

 - to identify in the RSI populationthe high-risk jobs with regard to CPD,

Relevance

 - exposure to occupational risk factors account for

15 to 20% of the etiologies of CPD

Operational goal

- to prioritize the preventive measures

by targeting the high-risk jobs.


Chronic pulmonary diseases of self employed in the craft trade and services sector

Design  - cross sectional study

- across the working population

- in 2010.

- using the health care reimbursement data base of the RSI

The RSI’s data center

receives the teletransmission from the recipients or providers of care.


Chronic pulmonary diseases of self employed in the craft trade and services sector

Geographical area

With an overall population of 4.9 million people, Provence-Alpes- Côte d'Azur is located in Southeastern France.

It comprises 6 departments

Variable continue : Moyenne (écart type); Variable nominale : Pourcentage

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Departments with different socio demographic characteristics

High rurality

High level of unemployment

Departments with different socio demographic characteristics


Chronic pulmonary diseases of self employed in the craft trade and services sector

Targeted population 

Includes 153 334 subjects insured by the RSI

  • Craftmen, shopkeepers, self-employed people and small business owners in crafts, trades and services

  • Currently active persons

  • Formerly active persons if now retired or disabled

Males or females aged between 30 to 90

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Chronic pulmonary diseases of self employed in the craft trade and services sector

How to asses the risk of CPD by measuring an Health Indicator

Chronic Pulmonary Disease

Reimbursements records

Billing repositoryclassification system

Health Indicator

(based on reimbursement data)

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Chronic pulmonary diseases of self employed in the craft trade and services sector

  • Respiratory consultations

  • prescription medications delivery approved only for a pneumology indication

  • Procedure coding

  • Pharmaceutical coding

Work loss wage compensation benefits for pulmonary disease (temporary or permanent disability)

  • diagnosis coding (ICD)

Domiciliary Oxygen Therapy (DOT)

  • Device Classification

  • casemix-based hospital financing system (T2A & PMSI)

Hospital Admission with a principal diagnosis of respiratory failure

Long Term Affection n° 14: Severe chronic respiratory failure

  • 30 Long Term Affections entitling to exemption of copayment (ALD30)

 Potential indicators of Chronic Pulmonary Disease

Reimbursements records

Billing repositories classification systems


Chronic pulmonary diseases of self employed in the craft trade and services sector

  • Respiratory consultations

  • prescription medications delivery approved only for a pneumology indication

  • Procedure coding

  • Pharmaceutical coding

Work loss wage compensation benefits for pulmonary disease (temporary or permanent disability)

  • diagnosis coding (ICD)

Domiciliary Oxygen Therapy (DOT)

  • Device Classification

  • casemix-based hospital financing system (T2A & PMSI)

Hospital Admission with a principal diagnosis of respiratory failure

Long Term Affection n° 14: Severe chronic respiratory failure

  • 30 Long Term Affections entitling to exemption of copayment (ALD30)

Indicators that have been chosen in our study

Insurance reimbursements

Repositories and classification systems


Chronic pulmonary diseases of self employed in the craft trade and services sector

The risk of CPD is higher for male worker than female

  • Advices:

  • Implementing preventive action targeted at male workers

  • Avoiding that tobacco consumption habits and men’s specific working conditions spread to women.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

The risk of CPD increase with age

  • Advices:

  • Acting early on any occupational exposure without waiting for the occurrence of the clinical symptoms (Preventive actions should begin at the stage of apprenticeship).

  • Post professional surveillance of the retired at risk.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Workers living in rural areas are at higher risk of CPD

  • Advices:

  • Chronic pulmonary diseases prevention initiatives should include rural areas.

  • Medical nursing homes could take a substantial part in the process.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Workers living in a high unemployment area have a higher risk of CPD

  • Advices:

  • CPD prevention initiatives should emphasize on high unemployment areas.

  • Unemployment reduction is needed.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Occupations at increased risk of CPD

  • bakers: allergy to flour ,

  • tobacconists: passive smoking ,

  • dental prosthetists: microparticles of grinding,

  • metal workers: vapors of welding and grinding,

  • shoemakers: glues.

(to be followed)

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Occupations at increased risk of CPD (followed)

  • vocational drivers: exhaust gases,

  • Bricklayers: mineral dust and vapors of pesticide treatment of buildings,

  • non sedentary storekeepers on stalls and markets: cold,

  • dressmakers, tailors, seamstresses: dust from cotton,

  • driving school instructors: exhaust gases,

  • restaurant owners: passive smoking and cooking fumes.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

What do the results of our research suggest?

  • With regard to our findings, preventives actions should be implemented concerning the following professionals:

    • Baker

    • Tobacconists

    • Dental prosthetists

    • Metal workers

    • Vocational drivers

    • Bricklayers

    • Stalls stands and market

    • Restaurants owners

  • More powerful epidemiological studies should be implemented for:

    • Shoemakers

    • Dressmakers, seamstresses

    • Driving instructors

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Chronic pulmonary diseases of self employed in the craft trade and services sector

What does the RSI intend to do ?

  • The RSI sets up actions called

    "RSI prevention pro", a new prevention program addressing the professional risks based on:

  • The reimbursement of a primary care practitioner consultation completely dedicated to occupational risk prevention,

  • Providing simple and practical recommendations adapted to the self-employed and small business owners.

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Bottom line


Chronic pulmonary diseases of self employed in the craft trade and services sector

Baker

Eumass Juin-2012

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Chronic pulmonary diseases of self employed in the craft trade and services sector

Tobacconist

Eumass Juin-2012

22


Chronic pulmonary diseases of self employed in the craft trade and services sector

Dental prosthetists

Eumass Juin-2012

23


Chronic pulmonary diseases of self employed in the craft trade and services sector

Metal worker

Eumass Juin-2012

24


Are 4 risky jobs with regard to chronic pulmomary disease in the rsi working population

are 4 risky jobs with regard to Chronic Pulmomary Disease in the RSI working population

Eumass Juin-2012

25


Chronic pulmonary diseases of self employed in the craft trade and services sector

Thank you for your attention

Contact: [email protected]

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